enCORE PDF

GE Healthcare
X-ray Bone Densitometer with enCORE v17

software - User Manual
This manual supports the following products: Lunar iDXA
Series, Lunar Prodigy Series, Lunar DPX Series
X-ray Bone Densitometer with enCORE

v17 software - User Manual
LU43616EN-2EN Revision 19 (September

2017)
© 2017 GE Healthcare
1 Safety ............................................................................................................25
Precautions for Standard Operating Procedures........................................ 25
Operator Safety............................................................................................. 26
Personnel Monitors ..................................................................................... 26
X-Ray and Shutter Graphics ....................................................................... 27
X-Ray Shutter............................................................................................... 27
X-Ray Power Supply .................................................................................... 27
Patient Safety ................................................................................................ 27
Mechanical Safety......................................................................................... 29
Symbols ......................................................................................................... 29
Sample Labels ............................................................................................... 30
Failsafe Circuit ............................................................................................... 35
X-Ray Shielding Requirements ..................................................................... 35
Electrical Safety............................................................................................. 36
Peripheral Configurations ........................................................................... 36
Scatter Radiation .......................................................................................... 37
2 Product Information ....................................................................................39
Intended Use ................................................................................................. 39
Indications for Use ........................................................................................ 39
Cautions for DXA Determinations ................................................................ 41
Device Descriptions ...................................................................................... 42
Scanner Table Assembly............................................................................... 47
Training Information ..................................................................................... 50
Classifications................................................................................................ 50
Installation and Operation............................................................................ 50
Software Installation..................................................................................... 50
Features......................................................................................................... 51
Hardware Features ..................................................................................... 51
Software Features ....................................................................................... 51
Quality Assurance (QA) Features ................................................................ 52
User Information ......................................................................................... 52
Options......................................................................................................... 52
3 Daily Use .......................................................................................................55
3 X-ray Bone Densitometer with enCORE v17 software - User Manual

Daily Use........................................................................................................ 55
Archive Exam Files....................................................................................... 55
Safe Use Guidelines ...................................................................................... 56
Emergency Stop Button................................................................................ 57
Test Emergency Stop Button ...................................................................... 57
Clean Scanner Table Environment............................................................... 57
Annual Maintenance..................................................................................... 57
X-Ray Tube and Laser Assembly Maintenance........................................... 58
4 Quality Assurance (QA) ...............................................................................59
Daily Quality Assurance Procedure.............................................................. 59
Precision and Accuracy ................................................................................ 60
QA Controls.................................................................................................... 61
QA Trend Reporting Options......................................................................... 61
Measure the Spine Phantom ........................................................................ 63
5 Measurement and Analysis ........................................................................67
Measurement: Overview and Warnings...................................................... 67
Measurement Modes .................................................................................. 68
Measurement Procedures: Overview .......................................................... 72
Select Existing Patient Record .................................................................... 72
Record New Patient Information................................................................ 73
Select Measurement Site ............................................................................ 75
Abort Measurement .................................................................................... 75
OneVision..................................................................................................... 76
QuickView .................................................................................................... 77
Analysis Procedures: Overview .................................................................... 77
Select Image ................................................................................................ 77
Adjust Image................................................................................................ 78
Advanced: Adjust ROIs................................................................................ 79
Advanced: Adjust Point Typing................................................................... 79
Examine Results .......................................................................................... 80
OneScan ........................................................................................................ 85
Turning OneScan On and Off...................................................................... 85
OneScan Measurement .............................................................................. 85
AP Spine Measurement and Analysis .......................................................... 86

AP Spine Measurement............................................................................... 86
AP Spine Analysis ........................................................................................ 89
Femur/DualFemur Measurement and Analysis .......................................... 91
Femur/DualFemur Measurement .............................................................. 91
Atypical Femur Fracture Measurement ..................................................... 93
Femur/DualFemur Analysis ........................................................................ 96
Forearm Measurement and Analysis......................................................... 110
Forearm Measurement ............................................................................. 110
Forearm Analysis....................................................................................... 113
Total Body Measurement and Analysis ..................................................... 114
Total Body Measurement.......................................................................... 114
Total Body Analysis ................................................................................... 116
Body Composition Measurement and Analysis ........................................ 121
Body Composition Measurement............................................................. 122
Body Composition Analysis ...................................................................... 124
Sarcopenia (Muscle Loss with Aging)......................................................... 139
Lateral Spine Measurement and Analysis ................................................. 143
Lateral Spine Measurement ..................................................................... 143
Lateral Spine Analysis ............................................................................... 146
LVA Morphometry Measurement and Analysis ......................................... 147
LVA Morphometry Measurement.............................................................. 147
LVA Morphometry Analysis ....................................................................... 149
LVA Spine Geometry Measurement and Analysis ..................................... 155
LVA Spine Geometry Measurement.......................................................... 155
LVA Spine Geometry Analysis ................................................................... 157
APVA Morphometry Measurement and Analysis ...................................... 158
APVA Morphometry Measurement........................................................... 158
APVA Morphometry Analysis .................................................................... 160
APVA Spine Geometry Measurement and Analysis .................................. 160
APVA Spine Geometry Measurement....................................................... 160
APVA Spine Geometry Analysis ................................................................ 162
Dual VA Measurement and Analysis .......................................................... 163
Pediatric Measurement and Analysis ........................................................ 163
Pediatric Measurement............................................................................. 164

Pediatric Analysis ...................................................................................... 165
Hand Measurement and Analysis .............................................................. 167
Hand Measurement .................................................................................. 167
Hand Analysis............................................................................................ 169
Orthopedic Hip Measurement and Analysis.............................................. 170
Orthopedic Hip Measurement .................................................................. 170
Orthopedic Hip Analysis............................................................................ 172
Orthopedic Knee Measurement and Analysis........................................... 174
Orthopedic Knee Measurement ............................................................... 174
Orthopedic Knee Analysis......................................................................... 176
Small Animal Measurement and Analysis ................................................. 177
Small Animal Measurement...................................................................... 177
Small Animal Analysis ............................................................................... 178
Custom Analysis.......................................................................................... 180
Custom Analysis Toolbar .......................................................................... 180
Precision Calculator .................................................................................... 181
Precision Wizard........................................................................................ 182
Custom Reference Population.................................................................... 182
Create a New Reference Population ........................................................ 183
Edit a Custom Reference Population ....................................................... 183
Delete a Custom Reference Population ................................................... 183
ScanCheck................................................................................................... 183
ScanCheck Checklist ................................................................................. 184
Adjusting ScanCheck Thresholds ............................................................. 184
6 Directory Management.............................................................................187
Move Scans ................................................................................................. 187
Copy Exam Files .......................................................................................... 187
Email Image Files ........................................................................................ 187
Edit Patients or Exams ................................................................................ 188
Delete Patients, Exams, or Images............................................................. 188
Change Image Type .................................................................................... 189
Batch Exam File Operations ....................................................................... 189
7 Reporting ....................................................................................................191
Reports ........................................................................................................ 191

DXA Reports............................................................................................... 191
Composer Reports .................................................................................... 192
Report Center .............................................................................................. 193
Create a Report ......................................................................................... 193
Select Additional Reports.......................................................................... 195
Change an Assessment for a Report ....................................................... 196
Configure Rules to Automatically Select Reports.................................... 197
Optimizing the Report Center ................................................................... 198
Style Sheets ................................................................................................. 199
Create a New Style Sheet ......................................................................... 200
Subreports ................................................................................................... 201
Create a New Subreport ........................................................................... 201
Add a Subreport to a Style Sheet ............................................................. 201
Configure a Subreport to Appear Only Under Certain Conditions ........... 202
Assessment Editor....................................................................................... 202
Composer Database ................................................................................... 205
Create a New Database............................................................................ 205
Change the Active Database.................................................................... 206
Practice Management Tools....................................................................... 206
Available Reports....................................................................................... 206
Add a Query............................................................................................... 209
Edit a Query ............................................................................................... 211
Delete a Query........................................................................................... 211
BMD Site/Region Filters............................................................................. 211
History Catalog.......................................................................................... 212
8 Database Maintenance.............................................................................213
Database Maintenance .............................................................................. 213
Compress Database ................................................................................... 213
Delete Database ......................................................................................... 214
Edit Database .............................................................................................. 214
Export Database ......................................................................................... 216
New Database............................................................................................. 216
Archive ......................................................................................................... 217
Restore Backup ........................................................................................... 218

Rebuild Database........................................................................................ 218
Import Entire Databases............................................................................. 219
Import Database Manually......................................................................... 220
Supported Import Options.......................................................................... 220
Task Scheduler ............................................................................................ 221
SQL Server Database Interface.................................................................. 221
External USB Hard Drive ............................................................................. 222
9 Troubleshooting.........................................................................................225
Troubleshooting .......................................................................................... 225
10 Screens and Toolbars ................................................................................227
Screens and Toolbars ................................................................................. 227
Using Screens ............................................................................................ 227
Using Toolbars........................................................................................... 227
Patient Block.............................................................................................. 227
Help Text .................................................................................................... 227
Main Screen................................................................................................. 227
Common Toolbar....................................................................................... 229
New Measurement Screen ......................................................................... 229
New Measurement Toolbar ...................................................................... 230
Analyze When Done Option...................................................................... 230
Home Scanner Arm................................................................................... 230
Park Scanner ............................................................................................. 231
Analyze Screen ............................................................................................ 231
Analyze Toolbar........................................................................................ 231
Results Tabs............................................................................................... 232
Directory Screen.......................................................................................... 233
Search ........................................................................................................ 233
Directory Toolbar....................................................................................... 234
Patient List and Exam List......................................................................... 234
Database Sidebar...................................................................................... 235
Quality Assurance Screen........................................................................... 235
Quality Assurance Toolbar........................................................................ 236
System Status............................................................................................ 236
Options ........................................................................................................ 236

User Options .............................................................................................. 236
Connectivity Options ................................................................................. 250
Error Log ...................................................................................................... 252
11 Security .......................................................................................................255
Introduction ................................................................................................. 255
Security Features ........................................................................................ 255
Access Controls ......................................................................................... 255
Windows User Account Requirements .................................................... 256
Application Security Settings.................................................................... 256
Create Windows User Groups ................................................................ 256
Add Users to Windows Groups............................................................... 257
Configure User Accounts for Electronic Signatures ................................ 257
Configure Application Functions Available to Groups............................. 257
Authentication ........................................................................................... 258
Authorization ............................................................................................. 259
Audit Controls ............................................................................................ 259
Malicious Software Protection.................................................................. 261
Workstation Security................................................................................. 263
Data Protection ......................................................................................... 263
Security Operations .................................................................................... 264
Network Security ....................................................................................... 264
Business Continuity ................................................................................... 264
Media Access Control Points .................................................................... 264
Remote Service ........................................................................................... 265
Network Interface Specifications and Risk Management ........................ 266
Using the GEHC Product Security Database ............................................. 268
A Specifications .............................................................................................271
Systems Specifications ............................................................................... 271
Physical Specifications................................................................................ 272
Operational Environment Specifications ................................................... 273
Storage and Transport Environment Specifications ................................. 276
Space Requirements................................................................................... 276
Leakage Current.......................................................................................... 279
Input Power ................................................................................................. 279

Fuse Capability ............................................................................................ 280
Collimator Specifications ............................................................................ 280
X-Ray Generator Technical Specifications ................................................ 281
X-Ray Tube Head Assembly ....................................................................... 289
X-Ray Tube Technical Information ........................................................... 290
Anode Heating/Cooling Curves ................................................................ 293
Filament Emission Characteristics ........................................................... 295
X-Ray Tube Assembly Heating/Cooling Curves....................................... 296
Maximum Scan Area (Long X Transverse)............................................... 297
Scatter Radiation Diagrams ....................................................................... 298
Current and Typical Dose Tables................................................................ 307
IEC and UL/CSA Certification...................................................................... 320
Electromagnetic Interference .................................................................... 320
Electromagnetic Compatibility (EMC) Performance .................................. 320
EMC Environment and Guidance.............................................................. 321
Declarations of Immunity and Emissions ................................................ 321
Minimum PC Requirements ...................................................................... 323
B Reference Data ..........................................................................................329
enCORE Reference Data ............................................................................. 329
Using the Reference Population Comparison ........................................... 329
Choosing Reference Population Options ................................................. 330
Configuring the Comparison to Reference Graph................................... 331
Reference Data Populations....................................................................... 332
C Adult Reference Data ................................................................................339
Bone Mineral Density (BMD) ....................................................................... 339
%Young Adult.............................................................................................. 340
%Age-Matched ........................................................................................... 341
%Age-Matched: Weight Adjustment ....................................................... 342
%Age-Matched Ethnicity Adjustment ...................................................... 343
%Age-Matched Nationality Reference Database ................................... 344
Reference Graph: Female and Male .......................................................... 344
Reference Graphs: Other Sites ................................................................... 345
Bone Mineral Density Reference Populations ........................................... 346
Comparison to Young Adult...................................................................... 347

Comparison to Age-Matched ................................................................... 347
Effect of Postmenopausal Years .............................................................. 350
Reference Population Database............................................................... 350
Age Adjustment ......................................................................................... 350
Weight Adjustment ................................................................................... 358
Lateral Spine Morphometry Reference Values.......................................... 359
Hip Axis Length............................................................................................ 362
References................................................................................................... 363
D Pediatric Reference Data ..........................................................................371
Bone Mineral Density (BMD) ....................................................................... 371
%Age-Matched ........................................................................................... 372
%Age-Matched Ethnicity Adjustment ...................................................... 373
%Age-Matched Nationality Reference Database ................................... 374
Reference Graph: Female and Male .......................................................... 374
Reference Graphs: Other Sites ................................................................... 375
Bone Mineral Density Reference Populations ........................................... 376
Comparison to Age-Matched ................................................................... 377
Reference Population Database............................................................... 380
Age Adjustment ......................................................................................... 380
Growth Indices ............................................................................................ 394
References................................................................................................... 401
E Body Composition Reference Data..........................................................403
Introduction ................................................................................................. 403
Android and Gynoid Regions of Interest.................................................... 403
Reference Populations that Support Total Body Composition
Reference Data ........................................................................................... 404
Body Composition Reference Values for Female Percent Fat.................. 404
Body Composition Reference Data for Male Percent Fat ......................... 406
Body Composition Percent Fat Reference Data..................................... 406
References................................................................................................... 409
F USA (NHANES 1999-2004) Total Body Reference Data ..........................411
Introduction ................................................................................................. 411
NHANES 1999-2004 Reference Population ............................................... 414
G AFF Phantom Study Results......................................................................457

Introduction ................................................................................................. 457
Accuracy of Beak Size................................................................................. 457
Reproducibility of Beak Size........................................................................ 458
Beak Size Dependence on Positioning....................................................... 458

Contact Information
www.gehealthcare.com
Headquarters/Legal Germany
Manufacturer
Beethoven Str. 239
GE Medical Systems Ultrasound & GE Medical Systems SCS
Primary Care Diagnostics, LLC. D-42655 Solingen
283 rue de la Minière
Street address: Germany
78530 BUC, France
3030 Ohmeda Dr. Phone: +49–212–2802–0
Madison, WI 53718 Fax: +49–212–2802–390
USA
Mailing address:
P.O. Box 7550

Madison, WI 53707-7550
USA
Phone: +1 (800) 437–1171
China France Asia/Pacific

No. 19 Changjiang Road 24 Avenue de l'Europe- CS 20 529 4–7–127 Asahigaoka
Wuxi, Jiangsu, 214028 78 457 VELIZY Hino-shi, Tokyo 191–8503
P.R.C. Phone: +33–1–34–49–5365 Japan
Phone: +86–510–85225888 Fax: +33–1–34–49–5406 Phone: +81–42–585–5111
Fax: +86–510–85226688 Fax: +81–42–585–3077
Physical Manufacturer Address Turkey

GE MEDICAL SYSTEMS MONTERREY, GE Medical Systems Türkiye Ltd. Şti
MEXICO S.A. DE C.V.
Esentepe Mah. Harman Sok. No: 8
Calle España No300, Parque
Industrial Huinalá, Apocada 34394 Şişli İstanbul Türkiye
Nuevo Leon CP 66645 MEXICO
GE Medical Systems Ultrasound & Primary Care Diagnostics, LLC, a General Electric company, doing business as GE Healthcare/GE
Santé au Québec.

Preface
This manual provides instructions for operating the software and scan table, safety and maintenance information, and technical
specifications for your bone densitometer.
The information in this manual is subject to change without notice. You may use or copy the software described in this manual only in
accordance with the terms of your software license, product warranty, or service contract agreements.
No part of this publication may be reproduced for any purpose whatsoever, stored in a retrieval system, or transmitted in any form or by any
means, mechanical, photocopying, recording or otherwise, without the express written permission of GE Healthcare.
Any reproduction, photocopying and recording in whole or part is prohibited. Any information contained herein shall not be disclosed to any
company viewed as a competitor to GE Healthcare.
GE Healthcare makes no warranty of any kind with regard to this material, and shall not be held liable for errors contained herein or for
incidental or consequential damages in connection with the furnishings or use of this manual.
The information contained in the manual is confidential and proprietary to General Electric. This information is provided only to authorized
representatives of GE Healthcare customers solely for the purpose of facilitating the use of GE Healthcare products. No information
contained herein may be disclosed to any unauthorized person for any purpose whatsoever without prior written consent of GE Healthcare.
Copyright © 2007-2017
GE Healthcare, Madison, Wisconsin. All rights reserved.
First year of CE Mark: 2007
Read this manual thoroughly before using the system or attempting to service any components. Unauthorized service may void system
warranties or service contracts. Consult the GE Healthcare Customer Service Department before attempting any service: 800-437-1171
(U.S.A).
United States Federal law restricts this device to sale by or on the order of a licensed physician.
This is required per 21CFR801.109 (Code of Federal Regulations).
Lunar iDXA, Prodigy, DPX, and CoreScan are trademarks or registered trademarks of General Electric Company. All other product and brand
names are registered trademarks or trademarks of their respective companies.
The devices for which this manual is used may also be marketed under the following names:
Lunar iDXA* Series

iDXA
iDXA Advance
iDXA Pro
iDXA Forma
Lunar iDXA
Lunar Prodigy* Series

Prodigy Advance
Prodigy Advance Compact
Prodigy Primo
Prodigy Primo Compact
Prodigy Pro
Prodigy Pro Compact
Prodigy Forma
Primo
Primo Compact
Prodigy
Prodigy Compact
Lunar DPX* Series

DPX-NT
DPX-MD+
DPX Bravo
DPX Duo
DPX Pro
MD+
Bravo
Duo
* are trademarks of General Electric Company.

Throughout this manual the term “image” is used to indicate a Dual-energy X-ray Absorptiometry (DXA) image, which is constructed from
low-energy and high-energy signals. Depending on the intended use, when a DXA image is displayed for a quantitative application such as
Spine or Femur BMD, the image is labeled “Image Not for Diagnosis.”
For applications such as Lateral Vertebral Assessment (LVA) running on Prodigy or iDXA, the image is labeled “Image for Spine Morphometry
Assessment Only.” For applications such as Atypical Femur Fracture (AFF) running on Prodigy or iDXA, the image is labeled “Image for
atypical femur fracture assessment only”.
The simple term “image” is used throughout the manual for readability.

License and Warranty Information
Please carefully read the following terms and conditions before installing or operating the GE Healthcare Software ("Software"). By installing
or using the Software in Your GE Healthcare product, You indicate your acceptance of these terms and conditions. If You do not agree with
the terms and conditions, do not install or operate the Software and return it to GE Healthcare.
The Software has been provided to You for use on a specific GE Healthcare product. The Software is provided under the terms of this
agreement and is licensed to You, not sold. Your rights to use the Software are subject to the terms and conditions contained within this
License Agreement and GE Healthcare reserves any rights not expressly granted to You. This license is non-exclusive and a non-transferable
license to use the GE Healthcare Software. Re-distribution of Software or any documentation provided to You by GE Healthcare is strictly
prohibited.
This product includes some software components that are licensed under the GNU General Public License (GPL). Source code for GPL
components is available upon request.
The terms and conditions of this License Agreement and Limited Software Warranty are as follows:
1. LICENSE.
This License allows You to:
(a) use the Software on a product in accordance with the accompanying documentation. To "use" the Software means that the Software
is either loaded in the temporary memory of a computer or installed on any permanent memory or media of a computer (e.g., hard
disk, CD-ROM, optical disk, zip disk, and the like);
(b) make one (1) copy, in machine-readable form, of the Software as provided to You solely for the purposes of backup; provided that such
copy includes the reproduction of any copyright notice or other proprietary notice appearing in or on such Software.
2. LICENSE RESTRICTIONS.
(a) YOU MAY NOT, EXCEPT AS EXPRESSLY PROVIDED FOR IN THIS LICENSE: (i) DECOMPILE, DISASSEMBLE, OR REVERSE ENGINEER THE
SOFTWARE (except to the extent applicable laws specifically prohibit such restriction); (ii) COPY, MODIFY, ADAPT, TRANSFER, TRANSLATE, RENT,
LEASE, GRANT A SECURITY INTEREST IN, OR LOAN THE SOFTWARE OR ANY PORTION THEREOF; (iii) CREATE DERIVATIVE WORKS BASED UPON
THE SOFTWARE OR ANY PORTION THEREOF; OR (iv) REMOVE ANY COPYRIGHT OR PROPRIETARY NOTICES OR LABELS IN OR ON THE SOFTWARE.
(b) You understand that GE Healthcare may update or revise the Software, and in so doing incur no obligation to furnish such updates to You
under this License. GE Healthcare has no obligation to improve, update or support the Software in the future.
(c) In the event the instrument or product designated for the Software is sold or otherwise transferred to a third party, that party is not
authorized to use the Software unless they first pay to GE Healthcare the applicable license fee and agree to the terms and conditions of a
Software License Agreement. Upon transfer of the Software or any copy thereof, the License granted hereunder shall terminate immediately.
3. TERM AND TERMINATION.

This License is effective until terminated. This License will terminate immediately without notice from GE Healthcare or judicial resolution if
You fail to comply with any provision of the License. Upon any termination of this License, You agree to return or destroy the Software, all
accompanying written materials and all copies thereof in any form. Section 5 will survive any termination.
4. EXPORT LAW.
You agree that neither the Software nor any direct product thereof is being or will be shipped, transferred or re-exported, directly or indirectly
into any country prohibited under United States law or regulations promulgated thereunder.
5. WARRANTY.
GE Healthcare warrants that, to the best of our knowledge, the software provided with this License will perform as described in the
product's operator's manual and the technical specification for this Software. This limited warranty is contingent upon proper use of the
Software and does not cover any Software which has been modified, subjected to malicious logic, unusual physical or electrical stress, or
used on computer equipment not specified by GE Healthcare.
GE Healthcare does not warrant that the functions contained in this Software will meet your requirements, or that the operation of the
Software will be uninterrupted or error- free. Statements made about this Software do not constitute warranties and shall not be relied upon
by You in deciding whether to purchase the GE Healthcare product or use the Software. IN NO EVENT SHALL GE Healthcare BE LIABLE TO
YOU FOR ANY DAMAGES ARISING OUT OF THE USE OR INABILITY TO USE SUCH SOFTWARE.
THE SOLE AND EXCLUSIVE REMEDY IN THE EVENT OF DEFECT IS EXPRESSLY LIMITED TO THE REPLACEMENT OF THE SOFTWARE PROVIDED. IF
FAILURE OF THE SOFTWARE HAS RESULTED FROM ACCIDENT OR ABUSE, GE HEALTHCARE SHALL HAVE NO RESPONSIBILITY TO REPLACE
THE SOFTWARE.
GE Healthcare will consider this warranty to be void if You fail to comply with the terms in the Software License Agreement.

6. TITLE.
Title, ownership rights, and intellectual property rights in the Software shall remain with GE Healthcare. This Software is protected by the
copyright laws and treaties.
7. MISCELLANEOUS.
This Agreement represents the complete agreement concerning this License and may be amended only by a writing executed by both
parties. The License is governed by the laws of the State of Wisconsin, U.S.A. without regard to its conflict of laws principles. If any provision
of this Agreement is held by a court of competent jurisdiction to be unenforceable, that provision shall be enforced to the maximum extent
permissible and/or reformed only to the extent necessary to make it enforceable, and the remaining provisions of this Agreement will not
be affected or impaired in any way. If any legal action or proceeding is brought for the enforcement of this Agreement, or because of
any alleged dispute, breach, default or misrepresentation in connection with any of the provisions of this Agreement, the successful or
prevailing party shall be entitled to recover reasonable attorneys' fees and other costs incurred in such action or proceeding, in addition to
any other relief to which such party may be entitled.

Registration
Government health departments can require medical facilities to register diagnostic x-ray equipment. Many municipal and state health
agencies require medical health facilities to employ certified radiologic technologists to operate diagnostic x-ray devices. Contact your local
regulatory authorities or GE representative for registration guidelines and regulation compliance.

Disposal of Materials
The scanner contains lead (for x-ray shielding) and one of the following: sodium iodide, cadmium telluride, Lutetium Yttrium Silicon
Dioxide (LYSO), or cadmium zinc telluride (used for x-ray detection).
WEEE Label
This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be
collected separately. Please contact an authorized representative of the manufacturer for information concerning the decommissioning of
your equipment.
If you contract with GE Healthcare for the disposal of your scanner, GE Healthcare will properly dispose of these materials. If you choose
to dispose of your scanner yourself, both substances must be disposed of in accordance with local regulations. Contact your local GE
representative for WEEE information.

FDA Certified Components
Lunar iDXA Series
The following table gives components certified to the FDA for use with Lunar iDXA series scanners. The tables are updated periodically.
Contact GE Healthcare for a current listing of compatible components.
Component Description GE Model
Tube head GE Medical Systems Ultrasound & 40782

assembly Primary Care Diagnostics, LLC iDXA
Series X-Ray Tube Head Assembly
X-ray controller GE Medical Systems Ultrasound & 41718

Primary Care Diagnostics, LLC iDXA
Series X-ray Controller
Collimator GE Medical Systems Ultrasound & 42129

Primary Care Diagnostics, LLC iDXA
Series Collimator Assembly
PRODIGY Advance 301000 and higher, PRODIGY 301000 and higher

The following tables give components certified to the FDA for use with Prodigy series scanners. The tables are updated periodically. Contact
GE Healthcare for a current listing of compatible components.

Primary Care Diagnostics, LLC single
board controller
High voltage power GE Medical Systems Ultrasound & 7681

supplies Primary Care Diagnostics, LLC Model:
2907 7681
GE Medical Systems Ultrasound

& Primary Care Diagnostics, LLC
Model: SBD40PN280X2890 or
SBD40PN280X4445
Tube head GE Medical Systems Ultrasound & 8743 or 45645

assembly Primary Care Diagnostics, LLC X-Ray
Tube Head Assembly
Collimator GE Medical Systems Ultrasound 8915

PRODIGY Collimator Assembly

PRODIGY Advance 40000-141999, PRODIGY 13000-13999

board controller

supplies Primary Care Diagnostics, LLC Model
2907 7681

Model SBD40PN280X2890 or
SBD40PN280X4445
Tube head GE Medical Systems Ultrasound & 8743 or 45645

assembly Primary Care Diagnostics, LLC X-Ray
Tube Head Assembly

Primary Care Diagnostics, LLC Prodigy
Collimator Assembly
DPX-NT/PRO/MD+/72000 and higher/90000 and higher

The following give components certified to the FDA for use with DPX-NT/PRO/MD+ scanners. The tables are updated periodically. Contact
GE Healthcare for a current listing of compatible components.

board controller

2907 7681

Model SBD40PN280X2890 or
SBD40PN280X4445

Tube head assembly GE Medical Systems Ultrasound & 8548 or 45649

Primary Care Diagnostics, LLC X-Ray
Tube Head Assembly

Primary Care Diagnostics, LLC DEXA
Collimator Assembly
DPX Duo, DPX Bravo
X-ray controller GE Medical Systems Ultrasound & Primary 41500

Care Diagnostics, LLC single board controller

SBD40PN280X2890 or SBD40PN280X4445
Tube head assembly GE Medical Systems Ultrasound & Primary 8548 or 45649
Care Diagnostics, LLC X-Ray Tube Head
Assembly
Collimator GE Medical Systems Ultrasound & Primary 7767

Care Diagnostics, LLC DEXA Collimator
Assembly

Operator Profile
The intended users of the DXA scanner are medical professionals with knowledge and experience required to work with x-ray equipment.

Safety
1
Precautions for Standard Operating Procedures
Use of controls or adjustments or performance of the procedures other than
those specified herein may result in hazardous (laser or x-ray) radiation
exposure.
1. Do not attempt to operate the x-ray bone densitometer without first reading
this manual.
2. Do not remove the assembly panels or attempt any repairs without prior
instructions from authorized personnel.
3. Perform the Quality Assurance procedure each morning. If any test fails, check
the position of the calibration block and rerun the QA procedure. If a test fails
again, contact GE Support. Also, call GE Support if more than two failures occur in
a one-week period. If the room temperature changes more than 5°C during the
day, perform another daily QA.
4. If the patient is or might be pregnant, always contact the patient's physician
before performing a scan.
5. Remain in visual contact with the patient while a scan is in progress. Ensure that
the patient does not move during the measurement. Minimize the amount of time
the patient lies flat on the scan table.
6. Restrict access to the room to authorized personnel.
7. Do not attempt to service any of the system's electrical components while the
x-ray bone densitometer is turned ON. High voltage is used to produce x-rays.
8. Radiation safety information is located within this manual you received with your
system. Review this information before operation.
9. To stop the x-ray bone densitometer in an emergency, press the emergency
stop button on the scan arm. DO NOT use the emergency stop button to routinely
abort a scan.
10. Immediately remove any fluids spilled on the pad or any surface of table.
11. All surfaces should be cleaned to meet site's guidelines for handling blood and
body fluids. Pad material may be damaged by certain chemicals. Use appropriate
hospital grade disinfectant (for example: Cidex®, HB Quat, Precise®, PDI) followed
by mild detergent.
12. Do not generate x-rays through the use of remote applications.
13. Protect the computer against malicious logic and unauthorized network
access. Only allow authorized user access. Prevent virus attacks by using

Safety
firewalls, anti-virus software and software patch updates. Contact your local GE
representative for more information.
14. DPX Duo: Extend the step the full distance to provide maximum surface area for
the patient to get on and off the table without risk of injury.
15. DPX Duo: Do not place an excessive load on foot rest stirrup (maximum load
is 60 pounds), drawers (maximum load is 100 pounds), or leg extension table
(maximum load is 300 pounds).
16. DPX Duo: Do not sit on leg extension table.
Operator Safety
Because the DXA has two control points (PC and front panel), the operator should
visually ensure that no person is near moving parts, pinch points, or the x-ray beam
before starting a scan. The operator must understand the use of the emergency stop
button on the front panel. See Emergency Stop Button (57).
DPX NT/MD, DPX Duo/Bravo, and Prodigy scanners: To avoid scatter radiation, the
operator should remain at least 3 feet (1 meter) away from the center of the scanner.
iDXA scanners: To avoid scatter radiation, the operator should remain at least 6 feet (2
meters) away from the center of the scanner.
Maximizing the distance from the patient will decrease the operator’s exposure
to scatter radiation; however, the operator should maintain visual or voice contact
with the patient at all times. Optional protective equipment will further reduce the
operator’s exposure to scatter radiation.
Personnel Monitors
Personnel monitors are not necessary to operate the scanner.
It is not likely that you can receive more than 25% of the maximum permissible x-ray
dose from the scanner. However, some facilities choose to use personnel monitors.
Refer to your city, county or state Health Department or Radiation Safety Officer
for your facility's policy.
Film badges and thermal luminescent dosimeter (TLD) badges are obtained from a
supplier accredited by the National Voluntary Laboratory Accreditation Program for
personnel dosimetry processing.
The following is a sample situation for a clinic measuring an AP spine and Dual Femur
on 5 subjects per day with an exposure rate of 0.18mR/hr at a distance of 2 meters
estimated from the iDXA isodose curves.
Sample Calculation for Estimated Exposure per Year from Scatter with iDXA
Densitometer
Scan Type Mode Average Scan Equivalent
Scans/Day Time/Day 2.5 mA Scan
(sec/day) Time/day
(sec/day)
AP Spine Standard 5 260 260
Dual Femur Standard 5 535 535
2.5 mA Scan Time per Day (sec) 795
2.5 mA Scan Time per Day (hours) 0.221

Safety
Scan Type Mode Average Scan Equivalent

Scans/Day Time/Day 2.5 mA Scan
(sec/day) Time/day
(sec/day)
2.5 mA Scan Time per Week (hours) 1.11
2.5 mA Scan Time per Year (hours) 57.5
2.5 mA Exposure from Isodose Plots (mR/hr) 0.18
Total Exposure for 1 Year (mR) 10.3

Total Absorbed Dose for 1 Year (mRad) 0.92 Rad/R 9.5
X-Ray and Shutter Graphics

During a measurement or Quality Assurance procedure, x-ray and shutter graphics
are shown on the computer monitor. The graphics are green to indicate x-rays are off
and the shutter is closed, and yellow to indicate x-rays are on and the shutter is open.
X-rays off and shutter closed (green)
X-rays on and shutter open (yellow)
X-Ray Shutter
When power to the scanner is interrupted during a measurement or Quality Assurance
procedure, the shutter closes and the x-ray tube stops generating x-radiation.
X-Ray Power Supply

The x-ray tube assembly uses high voltage to generate x-rays. DO NOT touch
internal components. DO NOT attempt to service internal components.
Patient Safety
Pinch Points
This label identifies the location of possible pinch points.

Safety
When the scanner arm is in motion, make sure possible pinch point areas are clear at
all times. Patient limbs must remain inside the boundaries of the table top. A pinch
point is possible between the scanner arm and table.
Laser Safety
DO NOT STARE INTO THE LASER BEAM during patient positioning and Quality
Assurance procedures. This label is located under the scanner arm and shows the
location of the laser aperture:
The laser aperture is located on the underside of the scanner arm, facing the patient.
Keep the laser aperture away from the patient’s eyes during patient positioning.
Radiation Safety
X-ray exposure: The system makes radiation when electric voltage is supplied to, and
current flows through, the x-ray tube. During a measurement, the shutter opens to let
a beam of radiation pass through the scanner table and patient.
For iDXA systems, the nominal radiation field at the scanner table top is 18.4 mm x
3.3 mm.
For Prodigy systems, the nominal radiation field at the scanner table top is 19.5 mm x
3.4 mm.
For DPX systems, the nominal radiation field at the scanner table top is 2 mm.
Lead oxide shielding surrounds the x-ray tube insert inside the tube housing assembly
and reduces radiation levels around the scanner table.
Leakage radiation: < 0.4 mR/hr at 1 meter.

Safety
Skin Entrance Dose

Refer to Current and Typical Dose Tables (307) for irradiation times and skin entrance
doses. A Victoreen model 530 Precision Electrometer/Dosemeter with a Model 660-5
Ion Chamber was used to measure the X-ray entrance dose.
Mechanical Safety
The scanner arm moves down the entire length of the scanner table. Make sure the
patient does not interfere with the movement of the scanner arm to prevent possible
injury. In addition, make sure that there are no objects behind the scanner table that
might obstruct movement of the scanner arm.
iDXA scanners: Weight applied to the scan table bed must not exceed 204 kg (450 lb).
DPX NT/MD+ scanners: Weight applied to the scan table bed must not exceed 136
kg (300 lb).
DPX Duo/Bravo and Prodigy scanners: Weight applied to the scan table bed or
footstep (DPX Duo only) must not exceed 159 kg (350 lb).
Symbols
Symbol Name Description
Electronic Instructions Symbol indicating that the Instructions for Use
for Use are supplied in electronic form
Emergency Stop Shows the location of the emergency stop

button
or
Focal Point Symbol from EN60417-1, 5327
Functional Earth Shows location of Functional Earth terminal
Laser On Shows the location of the Laser On indicator .
Permanent Filtration Symbol from EN60417-1, 5381

Safety
Symbol Name Description

Power Off Shows the switch position for Power Off
Power On Shows the location of the Power On indicator

and the switch position for Power On
Protective Earth Shows location of Protective Earth terminal
Refer to Instruction Alerts the user that the User Manual contains
Manual important safety information
Shutter Open Shows the location of the Shutter Open

indicator
Tube Insert Symbol from EN60417-1, 5337
Type B Equipment Shows that the scanner has Type B protection

against electrical shock
Warning Shows important safety warnings, such as the

location of pinch points
X-ray On Shows the location of the X-ray On indicator
X-ray Source Symbol from EN60417-1, 5338
Sample Labels
Actual label appearance may vary from the samples displayed
in this section.
For labels showing certification to 21 USCFR Subchapter J , the month in the

Manufactured field is translated below.
English Translation English Translation
January July
February August

Safety
English Translation English Translation

March September
April October
May November
June December
Laser Caution and Ionizing Radiation Label
This label shows that the scanner uses a Class II laser and produces ionizing radiation
(x-rays).
Laser Radiation. Do not stare into beam. Class 2 Laser Product. Laser wavelength is
655 nm.

Safety
Tube Housing Assembly Label
This label gives tube assembly and x-ray source characteristics information. It is
located on the tube head assembly (inside the scanner) and on the foot panel of the
scanner.
System Label
This label gives system input power requirements and compliance information. It is
located on the foot panel of scanners.

Safety
The Refer to Instruction Manual symbol indicates a need to read accompanying

documents.
The Person symbol refers to Type B applied parts (any exposed surface of the scanner
table assembly) for degree of electric shock protection per EN60601-1.
The Fan symbol denotes that ionizing radiation is generated.
The GOST symbol shows compliance with Russian regulations.
The CE mark shows compliance with the Medical Device Directive 93/42/EEC.
The ETL mark shows compliance to ANSI/AAMI ES60601-1 and CAN/CSA C22.2 No.
60601-1.
The EAC symbol shows that this product passed all conformity assessment (approval)
procedures that correspond to the requirements of applicable technical regulations
of the Eurasian Customs Union.
The Waste Receptacle mark indicates that the waste of electrical and electronic
equipment must not be disposed as unsorted municipal waste and must be collected
separately. Please contact an authorized representative of the manufacturer for
information concerning the decommissioning of your equipment.
High Voltage Power Supply Label
This label gives high voltage power supply (x-ray generator) information. It is located
on the high voltage power supply (inside the scanner) and on the foot panel of the
scanner.

Safety
X-ray Controller Label
This label shows x-ray controller compliance. It is located near the x-ray controller
(inside the scanner) and on the foot panel of the scanner.
Collimator Assembly
This label gives collimator assembly information. It is located on the collimator (inside
the scanner) and on the foot panel of the scanner.
Warning and Radiation Symbol Label
This label shows that the system uses ionizing radiation. It is found only on systems
delivered in the United States. Always obey instructions for safe operation.

Safety
Grounding Reliability Label
This label states that grounding reliability can be maintained only when using a
"Hospital Grade" or "Hospital Only" receptacle. It is found on all power cords of
systems delivered in the United States.
Unique Device Identification Label
Every medical device has a unique marking for identification. The UDI marking
appears on the device labeling.
This is only an example of a UDI marking.
Failsafe Circuit
During operation, the scanner is constantly monitored for diagnostic failures. If a
diagnostic failure occurs, the failsafe circuit stops power to the scanner motors and
disables the x-ray system. A message is shown on the computer that describes the
failure. Call GE Support or your GE distributor and provide the failure description.
X-Ray Shielding Requirements

Install a Caution: X-Radiation sign in the area or room where the system is operated.
Because of low leakage levels of radiation from the x-ray tube assembly, additional
shielding in the walls, floor, or ceiling is not necessary. However, call your state or local
health and radiation safety departments for shielding requirements.

Safety
Electrical Safety
Insulate patient from any metal associated with the DPX Duo by using a
non-conductive material during cauterization or similar treatments to avoid
shock or burns.
Do not plug additional outlet strips or extension cords into power source
connected to scanner.
To avoid risk of electric shock, this equipment must be connected only to a

supply mains with protective earth. Scanner power cord must be connected
directly to the wall outlet or to a redundantly grounded UPS. Never power the
scanner via an outlet strip.
Peripheral Configurations
The correct connection of the computer and all peripherals is necessary to
maintain electrical safety. The signal cable of the scanner is intended only for
connection to an approved computer. Call GE Support or your GE distributor
before adding peripherals.
Operator shall not touch patient and computer or peripherals simultaneously.
Failure to use outlet strips properly can cause medical electrical system
leakage currents in excess of 100 microamperes. For more information on
medical electrical systems, refer to IEC 60601-1.
Standard Room Configuration

The computer, peripherals, and all other equipment must be located more than 1.5 m
from the scanner. If an outlet strip is used to power the computer, it must be mounted
off the floor so that it does not touch other equipment.
A modem and/or network connection can be made at any time if you are using the
standard room configuration.
Small Room Configuration
You must power the computer, peripherals, and all other equipment with an isolating
transformer if the room is too small to maintain at least 1.5 m of separation between
the scanner and all other equipment.
The isolation transformer supplied by GE Healthcare has a maximum output
of 400/500VA. Because the transformer includes a multiple socket outlet, only
system-related equipment shall be powered by the isolation transformer.
A modem and/or network connection can only be made in the small room
configuration if all exposed metal surfaces of the computer and peripherals are out of
the patient environment.

Safety
Scatter Radiation
Refer to Scatter Radiation Diagrams (298) to see isodose diagrams of scanner scatter
radiation.

Safety

Product Information
2
Intended Use
The bone densitometer is designed to estimate the bone mineral density and body
composition (lean and fat tissue mass) of patients when medically indicated by their
physicians.
This manual provides instructions for operating the software and scan table, system
information, and maintenance information.
United States Federal Law restricts this device to the sale, distribution, and use by or
on the order of a physician (USA only).
Variables Affecting Scan Results

Scan results can be affected by operator technique and patient variability.
Operator technique refers to patient positioning and scan analysis. To minimize
technique variables:
● Establish consistent positioning and scan analysis routines by using anatomical
landmarks when positioning patients.
● During analysis, manipulate raw scan data only when absolutely necessary.
Patient variability refers to changes in the patient's medical history, metabolism, and
diet. It also refers to diagnostic procedures that involve radionuclide uptake and
medical treatment, and the presence of external radiation (particularly the use of
other radiation-generating devices in the vicinity of the system). To minimize patient
variability:
● Thoroughly familiarize yourself with the patient's history.
● Install the scanner in an environment effectively shielded from other sources of
external radiation.
Indications for Use

The x-ray bone densitometer supports the following indications for use:
Provides an estimate of bone mineral density at various anatomical sites (Spine,
Femur, Total Body, and Forearm). These values can then be compared to an adult
reference population at the sole discretion of the physician.
Provides an assessment of relative fracture risk based on the patient's T-score value
using the categories of fracture risk defined by the World Health Organization (WHO).
Provides an assessment of 10-year fracture risk using WHO FRAX model.

Product Information
Provides a standardized bone density report using data from the densitometer and
physician-generated assessments based on the patient's demographics, which can
assist the physician in communicating scan results to the patient and the patient's
referring physician.
Optional Hand BMD software estimates the BMD at the hand.
Optional Dual-Energy Vertebral Assessment software provides an x-ray image of the
spine for qualitative visual assessment in order to identify vertebral deformations and
estimate vertebral heights (morphometry).
Optional Orthopedic software estimates periprosthetic BMD of an orthopedic hip
or knee implant (pre- and post-surgery).
DPX only: Optional Pediatric software option expands the range of bone densitometry
reference data to include ages 5 through 19 years. The software provides a
comparison of measure variables obtained by dual energy x-ray absorptiometry to
a database of reference values. These data can be used for comparative purposes
at the sole discretion of the physician.
Optional Complete Pediatric software option measures bone mineral content (BMC),
bone mineral density (BMD) and body composition (lean body mass and fat mass)
in patients from birth to 20 years of age. The software provides a comparison of
measured variables obtained by dual energy x-ray absorptiometry to a database
of reference values for patients 5-19 years of age. These data can be used for
comparative purposes at the sole discretion of the physician. The software does
not provide a reference population for comparative purposes for patients younger
than 5 years of age.
Optional Body Composition software measures the regional and whole body bone
mineral density (BMD), lean and fat tissue mass, and calculates other derivative values
which can be displayed in user-defined statistical formats and trends, and compared
to reference populations at the sole discretion of the healthcare professional. Some of
the diseases/conditions for which body composition values are useful include chronic
renal failure, anorexia nervosa, obesity, AIDS/HIV, and cystic fibrosis.
The MirrorImage function used on the GE Lunar DXA bone densitometers can be
used to estimate the total body composition and bone mineral density (BMD) when
regions of the body are outside of the scan window by using scanned data from the
corresponding region(s) on the opposite half of the body.
Optional CoreScan* software estimates the Visceral Adipose Tissue (VAT) content
within the android region in a male or female population between the ages of 18
and 90 with a BMI between 18.5 and 40, excluding pregnant women. The content
that is estimated is the VAT Mass and VAT Volume. The values can be displayed in
user-defined statistical formats and trends. Some of the diseases/conditions for which
VAT estimation can be useful include hypertension, impaired fasting glucose, impaired
glucose tolerance, diabetes mellitus, dyslipidemia and metabolic syndrome.
Optional total body composition software estimates the Resting Metabolic Rate (RMR)
in the male or female population age 18 and older. The data can be displayed in
user-defined statistical formats and trends.
Optional total body composition software estimates the Relative Skeletal Muscle Index
(RSMI) in the male or female population age 18 and older. The data can be displayed in
user-defined statistical formats and trends.
Optional Advanced Hip Assessment (AHA) software provides a measurement of hip
axis length (HAL) and a mean value of HAL for Caucasian and Asian females on

Product Information
femur images. It also calculates hip geometry values used to evaluate the structural
properties of the hip.
The DPX-Duo has special mechanical features including stirrups, storage drawers, and
patient step to allow use as an exam table when bone densitometry is disabled and
the scan arm is rotated and locked parallel to the table.
Optional Atypical Femur Fracture (AFF) software uses femur images to visualize focal
reaction or thickening along the lateral cortex of the femoral shaft which may be
accompanied by a transverse radiolucent line. This software provides measurements
of the lateral and medial cortex width and quantifies focal thickening of the lateral
cortex along the femoral shaft. The beaking index can be displayed and trended
across serial scans.
Optional sarcopenia software calculates values based on published definitions and
thresholds using measured appendicular lean mass in combination with patient
demographics and entered values of muscle strength and physical performance.
These values may be useful to health care professionals in their management of
sarcopenia.
Cautions for DXA Determinations

You should be aware of the following factors which may affect the clinical accuracy of
DXA spine estimates: marked distortions of skeletal architecture (e.g., osteophytes,
degenerative disc disease, spinal arthritis, spondylolisthesis, kyphoscoliosis, and
vertebral fractures) and significant calcium deposits in the aorta can falsely elevate
spine bone mineral values. Regions that contain these dystrophic calcifications can be
excluded from the scan analysis in some cases. The scanner can be used to monitor
changes in bone mineral over time in patients with these disorders, but caution must
be taken in interpretation. Use DXA estimates as an aid to other methods in the
evaluation of patient bone mineral status in the clinical setting.
In addition, spine estimates will be difficult to interpret for patients with orthopedic
metal devices and previous surgical interventions, such as bone grafts. Radiographic
contrast material and radiopharmaceuticals used for myelograms, barium enemas,
and other diagnostic tests prevent accurate estimates. Barium clears the body within
a few days, but the oil-based dyes used in myelograms several years ago may remain
within the body for years. A three-day waiting period is sufficient time for barium
and most radiopharmaceuticals to be completely discharged from the body. DXA
measurements will be difficult to interpret for patients taking Strontium or Strontium
ranelate because DXA overestimates the actual bone mass due to the higher atomic
number of Strontium compared to Calcium.
Femur estimates will be difficult to interpret for patients with orthopedic metal devices
and previous surgical interventions. The most common complicating factors for femur
estimates are prosthetic devices and surgical implants in the region of the bone scan.
Results may be adversely affected if the patient has difficulty with the desired 25°
inward rotation of the leg or with maintaining this position without movement.
Total Body estimates require consistent patient positioning for accurate results and
will be difficult to interpret for patients with orthopedic metal devices and previous
surgical interventions. The operator should pay particular attention to the location of
the patient's arms, keeping the positioning the same for each scan. Results may be
affected if the patient moves during the scan.

Product Information
Device Descriptions
Structure
The device includes the following basic components:
1. An x-ray source with appropriate filtration to form a well-defined dual-energy
beam,
2. An x-ray detector capable of measuring the attenuated beam at two energy levels,
3. A support for holding the subject between the source and detector,
4. A mechanical means to move the source and detector in a rectilinear scan of a
selected area of the subject’s body, and
5. Software and electronic controls for the previously mentioned components.
6. Where applicable, phantoms and positioning blocks are used with the system.
Depending upon the enabled features, these components may vary or may not
be required.
7. Optional system components include the small room kit, which is used when
the PC is close to the table; encapsulated phantom, which is an encapsulated
aluminum spine in an acrylic block; and an uninterruptible power source (UPS).
The bone densitometer is divided into a scanner and a computer. The scanner
comprises the x-ray source and detector, the patient table, the mechanical drive
system, and the lowest level portions of the control system. The scanner is in
communication with the computer, which is a standard PC. The computer runs the
enCORE software, and thus controls the scanner, acquires scan data from the scanner,
stores and analyzes the data, and interacts with the human operator.
DPX-Bravo and DPX-Duo

The DPX-Bravo and DPX-Duo models use pencil beam technology with a single-crystal
channel NaI detector and have a compact table design to provide space efficiency.
The DPX-Duo and the DPX-Bravo come equipped with a scan arm that swings to the
side of the table when not in use as a densitometer and to facilitate patient loading.
X-ray scanning is not possible until the scan arm is locked into the scan position. A
handle releases the scan arm interlock and allows operator to move the scan arm
for patient loading. Once the patient is loaded on the table, the operator moves the
scan arm back to scanning position and the arm locks into scan position. If a scan
is attempted without the scan arm locked into position, the following error will be
displayed:
Error Description:
Swing arm not locked in scanning position. Please lock before continuing.
Corrective Action:
Please try again. If the problem persists, contact GE Lunar Support for assistance.
To retract the scan arm once the scan is completed, home the scan arm.

Product Information
Pull the lever on the front of the scan arm towards you and push the scan arm to the
left until it rests along the back of the scanning table. The patient can then sit up and
the table is free of obstruction.
The power switch is located at the head of the table. There is also a roll at the head of
the table to store up to 21” x 3” (53.34 cm x 7.62 cm) exam paper. The table weight
limit is 159 kg (350 pounds).
DPX-Bravo
Item Description
1 Table pad
2 Swing scan arm
3 Scan arm control panel
4 Exam paper roll and power switch (head of scanner–not shown)
The DPX-Duo model also has mechanical features including stirrups, procedure
drawer, storage drawers, and patient step to allow use as an exam table when bone
densitometry is disabled and the scan arm is rotated and locked parallel to the table.

Product Information
DPX-Duo
Item Description
1 Patient step
2 Storage drawers
3 Stirrups
4 Table pad
5 Swing scan arm (in scanning position)
7 Exam paper roll and power switch (head of table–not shown)
8 Procedure drawer
DPX-NT/Pro/MD+
The DPX-NT, DPX-Pro, and DPX-MD+ models come in full and compact sizes and use
pencil beam technology with a single-crystal channel NaI detector. The power switch
is located on the lower front panel. The table weight limit is 136 kg (300 lbs).

Product Information
DPX-NT
Item Description
1 Power switch
2 Table pad
3 Scan arm
Prodigy/Prodigy Primo/Prodigy Advance/Prodigy

Pro/Prodigy Forma
Prodigy models come in full and compact sizes and use fan beam technology with a
16-channel detector. The power switch is located at the foot of the scanner. The table
weight limit is 159 kg (350 lbs).
Prodigy Series
Item Description
1 Power switch
2 Table pad

Product Information
Item Description
3 Scan arm
iDXA/iDXA Forma
The Lunar iDXA uses fan beam technology with a 64-channel detector, is a scanner
designed for optimal image quality, and supports patient's weights to 204 kg (450 lbs).
The power switch and exam paper roll is located at the head of the scanner.
Lunar iDXA Series
Item Description
1 Exam paper roll
2 Table pad
3 Scan arm
5 Power switch (head of scanner–not shown)
The Warning label identifies the location of possible pinch points. When the scanner
arm is in motion, make sure possible pinch point areas are clear at all times. The
technologist must keep both feet away from the moving carriage. Patient limbs must
remain inside the boundaries of the table top to avoid a pinch between the scanner
arm and table.

Product Information
Scanner Table Assembly

The term “scanner” is equal to “x-ray bone densitometer.”
Scanner Table
No modification of the Scanner Table assembly is allowed. For service, please
call GE Support or your GE distributor.
The scanner table is used to support the patient during a measurement or general
examination (DPX Duo only). In addition, the x-ray source assembly and other
electronics are contained inside the scanner table.
Scanner Arm
The laser light, emitted from an aperture on the scanner arm, helps you locate the
measurement start position. Positioning switches let you move the scanner arm until
the laser light is located at the correct start position. The start position is different for
each measurement type.
On DPX Duo/Bravo scanners, the scan arm has a release and locking mechanism
allowing the upper arm to swivel when the scanner is idle. The scan arm must be in
the locked position over the scanner table to perform a measurement.
Scan Arm Control Panel

Scan arm control panel: DPX Bravo/Duo

Product Information
1 Alarm indicator lights
2 Lever to lock/unlock swing arm
3 Positioning switches
4 Emergency stop button
Scan arm control panel: DPX NT/MD+/Prodigy/Prodigy Primo/Prodigy Advance

Scan arm control panel: iDXA


Product Information
4 Start scan button
The following table describes the indicators located on the scan arm control panel.
The x-ray, shutter, and laser indicators are considered low priority alarm conditions as
defined in IEC 60601-1-8. The power indicator is not considered an alarm condition.
Symbol Indicator Status (on)
Green (power) Power is supplied to the scanner table
Yellow (x-ray) X-ray tube assembly is supplying x-rays
Yellow (shutter) Shutter is open
Amber (laser) Laser is on
Emergency Stop Button

Push the red emergency stop button to stop the scanner arm and immediately shut
down x-rays in an emergency. Do not use the emergency stop button to routinely
stop the scanner during normal operation.
Positioning Switches
The positioning switches move the scanner arm and detector to the measurement
start position (the laser light indicates the position of the detector). The Back/Front
switch moves the detector across the width of the scanner table. The Left/Right switch
moves the scanner arm down the length of the scanner table.
Swing Arm Position Sensing Switches

On DPX Duo/Bravo scanners, the swing arm position sensing switches detect the
locking status of the swing arm and the swing arm latch. The swing arm latch must
be locked and the swing arm must be in the locked position over the scan table
before a measurement can be performed. Release of the swing arm latch during a
measurement will abort the scan and the measurement data will be lost.
Start Scan Button

On iDXA scanners, the start scan button initiates the patient measurement. The start
scan button is located on the display panel near the positioning switches.

Product Information
Training Information
GE Healthcare or its authorized distributors provide individual, hands-on training as
part of the installation procedure for your system. (GE distributors provide training
for systems installed outside the United States.) An Applications Specialist provides
information on software and hardware operations, and reviews the warnings and
cautions in the manuals.
Only trained technologists should operate the system. New

technologists should receive training prior to unsupervised
operation of the system. Additional training sessions
are available on request for a nominal fee. For more
information, contact the GE Customer Service Department at
888-281-4947, or your local GE representative.
Classifications
Protection against electric shock: Class I, Type B
Protection against water: IPX0
Operation mode: Continuous operation
The device can neither be used in flammable anesthetic mixture with air nor
non-flammable anesthetic mixture with oxygen or nitrous oxide.
Installation and Operation

Only individuals trained by GE Healthcare should service or install the x-ray bone
densitometer. Do not attempt to service the X-ray Bone Densitometer. Call GE Service
or your GE distributor for support.
Before operating the x-ray bone densitometer, review Safety (26).
Software Installation
If loading software, you will be asked for your system number and feature code during
the installation procedure. These numbers are printed on a sheet included with the
software.
1. Put the DVD in the DVD drive.
2. When the Installation window appears, select the product software option.
If the installation does not automatically start, select
My Computer, select the DVD drive, and double-click the
software installation icon.
3. Follow the screen prompts to install the program.

The enCORE installation program automatically applies Windows 7 32-bit Service
Pack 1 and validated Microsoft Security updates on English operating systems,
if not already installed. Once all updates are applied, the system automatically
restarts and continues with the installation of the enCORE product software. This
process may take up to 90 minutes.

Product Information
Features
Depending on the country, scanner model, and number of options you purchased, not
all of the features listed below may be included with your scanner:
Hardware Features
● DPX systems: Pencil beam technology.
● Prodigy and iDXA systems: Narrow-angle fan beam technology with Multi-View
image reconstruction.
● DPX systems: Single-element NaI detector.
● Prodigy and iDXA systems: Multi-element detector. Imaging performance meets or
exceeds 1.5 mm hole pairs and is limited by the Prodigy detector pitch of 3.2 mm.
● iDXA and DPX-Duo/Bravo systems: Paper roll dispenser.
● DPX-Duo/Bravo systems: Swing arm.
● DPX-Duo systems: Foot rests, patient step, two storage drawers, procedure tray.
Software Features
Not all features are available on all models.
● QuickView measurement application
● Total body measurement and analysis
● Pediatric spine measurement and analysis
● Pediatric total body measurement and analysis
● Pediatric femur measurement and analysis
● Pediatric assessments of growth and development including height for age, BMC
for bone area, bone area for height, lean body mass for height, and BMC for lean
body mass
● Lateral spine measurement and analysis
● Dual-energy vertebral assessment (lateral and AP)
● Spine geometry
● Hand measurement and analysis
● Small animal total body measurement and analysis
● ClearView filter for enhancing images by reducing soft tissue noise and improving
bone edges (user adjustable)
● Total body %fat and android/gynoid %fat estimation
● Resting Metabolic Rate (RMR) estimation
● Relative Skeletal Muscle Index (RSMI) estimation
● Sarcopenia calculator
● CoreScan – Visceral Adipose Tissue (VAT) estimation
● Body composition color coding and mapping
● AP spine measurement and analysis
● OneScan measurement application
● Femur measurement and analysis
● Atypical femur fracture measurement and analysis

Product Information
● DualFemur measurement and analysis

● Total body and regional tissue quantitation
● Android and gynoid ROI analysis on body composition
● Forearm measurement and analysis
● Orthopedic hip measurement and analysis (with extended Gruen analysis)
● Orthopedic knee measurement and analysis
● ScanCheck (formerly known as Computer Aided Densitometry, or CAD)
● Composer reporting tools
● Practice Management tools
● DICOM and HL7 interface capability
● SQL Server application
● TeleDensitometry
● Multi-user database capability
● OneVision capability
● Advanced Hip Assessment (AHA) hip strength analysis
● Custom region of interest (ROI) analysis
● Previous scan image comparison
● Automatic metal detection
● HIPAA Secure View
● Patient/exam directory with multiple databases
● Global UI with multiple languages, regional settings
● SmartScan for scan window optimization and dose reduction
● Automatic scan mode selection
● Auto analysis
● ROI comparison (copy)
● BMD or SBMD, BMC and area measurements
● Reference data: Lunar, NHANES, many regional populations, and custom options
● Reference data comparisons T/Z scores and percent YA/AM
● FRAX 10-Year Fracture Risk
● Trending
Quality Assurance (QA) Features

● QA automated test program
● QA trending
● Six-point calibration
● AP spine phantom
User Information
● User Manual
Options
● Uninterruptible power supply (UPS)

Product Information
● Small Room kit

● Encapsulated phantom
● PC cart
● Positioners
● Washable table pad

Product Information

Daily Use
3
Daily Use
1. Quality assurance: Every morning, before you start patient measurements,
complete the daily Quality Assurance procedure. Refer to Quality Assurance (59).
Make sure you save your printed results for future reference.
2. Measure patients: If time allows, enter the Primary, Secondary, and Additional
data for the patients you expect to measure during the day. Refer to Measurement
(72).
3. Analyze results: Analyze and print results immediately after each patient
measurement if time allows. Otherwise, analyze all of the patient files after the
last patient has been measured. Refer to Analysis (77).
4. Archive exam files: Archive your exam files before you leave for the day. In the
unlikely event of a computer malfunction, it is very important that you have
archived files of all of your patient measurements to rebuild your database. Refer
to Archive Exam Files (55) for archive procedures.
5. Shut down computer: At the end of the day, select Exit from the Main screen,
select Shut Down from the Close window, and click OK to close the program.
Do not turn off the scanner at the end of the day for
stationary systems.
Archive Exam Files

Each day, archive new exam files from your computer hard drive to an archive disk
or external hard drive.
The program identifies archived files by labeling them with the drive location and the
number of the archive disk. For example: the third archive disk located in drive A is
labeled A:A3. Labels for archive disks are shown in the Label column of the Image
file list on the Directory screen.
It is important that you write the archive number on each archive disk. If it is necessary
to restore archived files to the hard drive or rebuild your database, the program
requires that you use the appropriate archive disk according to its label.
1. Select Directory from the Main screen or the Common toolbar.

Daily Use
2. Complete one of these procedures:

Archive all exams for all 1. Select Archive from the Directory toolbar.
patients
2. In the dialog box, select Archive all exams for all
patients.
Archive all exams for all 1. Select a search field from the drop down menu.
patients in the current
2. Enter search criteria in the field provided.
search results
3. Click the Search button.
4. Select Archive from the Directory toolbar.
5. In the dialog box, select Archive all exams for all
patients in the current search results.
Archive all exams for 1. Select a patient from the Patient list.
selected patient
3. In the dialog box, select Archive all exams for selected
patient.
Archive selected exam 1. Select a patient from the Patient list.
2. Select the patient exam file you want to archive.
4. In the dialog box, select Archive selected exam.
3. Select OK.
The program archives the exam files from the computer hard drive to the archive
disk or external hard drive. The archive number for the file is shown in the Label
column of the Image list.
4. If an archive storage source needs to be initiated, the program prompts you to
insert a labeled archive disk in the appropriate disk drive. Insert a disk as directed.
Safe Use Guidelines

Obey these safety guidelines at all times.
● Read the manual before you operate the scanner.
● The technologist operating the scanner must remain in visual contact with the
patient during the measurement.
● Do not attempt to service the scanner. Call GE Support or your GE Distributor.
● When the scanner is not in use, make sure the Shutter Open, X-ray, and Laser
lights are off.
● Do not put excessive pressure on the scanner arm.
● Use the scanner table for patient measurements and examinations (DPX Duo) only:
do not sit, stand or lie on the table for other purposes.
● Do not let liquids touch the computer or scanner table mechanics and electronics.

Daily Use
Emergency Stop Button

Be prepared to abort the scan in the unlikely event arm motion stops with
the x-rays on.
The emergency stop button is the round, red button located on the scanner control
panel.
Do not use the emergency stop button to routinely stop the scanner during normal
operation.
1. Push the Emergency Stop button to stop a measurement in an emergency.
Power to the scanner table motors, x-ray tube head, shutter, and laser is turned off.
2. Select OK in the message window on the computer screen.
If there is a hardware problem, DO NOT try to measure a
patient. Call GE Support or your GE distributor.
Test Emergency Stop Button

Test the emergency stop button once a month, as follows:
1. Start a standard AP Spine measurement. Do not have a patient on the table.
2. Push the emergency stop button.
Make sure the X-ray and Shutter lights are off and that a message on the
computer monitor indicates the emergency stop button is activated.
3. On DPX NT/MD, DPX Duo/Bravo, and Prodigy system: Push the emergency stop
button again to reset the system.
4. Do not save the patient measurement.
If the emergency stop procedure does not work, call GE Support or your GE distributor.
Clean Scanner Table Environment

Vacuum and dust the system site weekly. Dust the surface of the system regularly
and use nonabrasive cleaners to remove dirt. Do not let liquids penetrate inside the
scanner table.
Do not connect a vacuum cleaner to the same electrical outlet as the scanner.
Proper cleaning and handling procedures must be followed to prevent the

possibility of cross-infections between subjects scanned on the same system.
Clean and disinfect the system according to your local and country specific
hygienic regulations.
Annual Maintenance
GE Healthcare recommends that you schedule annual preventive maintenance by
a GE-authorized service engineer after your warranty period expires. Contact GE
Support or your GE distributor.

Daily Use
X-Ray Tube and Laser Assembly Maintenance

There are NO USER-SERVICEABLE COMPONENTS inside the x-ray tube head and
laser assemblies.
DO NOT attempt on-site servicing. Call GE Support or your GE distributor immediately
if the system malfunctions.
DO NOT attempt to maintain or repair the components and scanner table. Doing so
voids all current warranty and service contracts.

Quality Assurance (QA)
4
Daily Quality Assurance Procedure
Complete Quality Assurance procedures daily. Make sure each QA procedure passes.
If your system does not pass a test, check the position of the calibration block and
complete the Quality Assurance procedure again. If the procedure fails a second time,
call GE Support or your GE distributor.
Complete a Quality Assurance (QA) test each morning before you measure a patient. If
the room temperature changes more than 5°C during the day, then perform another
Daily QA. This procedure calibrates and verifies functionality as well as the accuracy
and precision of the densitometer. The QA procedure should be performed a minimum
of once a week if the scanner is not being used. Save all QA printouts for one year.
Use the black calibration block to complete a QA test (the calibration block consists
of tissue-equivalent material with three bone-simulating chambers of known bone
mineral content). Leave the pad on the scanner table during the QA procedure.
1. Select Quality Assurance (F5) from the Main screen or select QA from the
Common toolbar.
2. Select Start.
A message instructs you to position the calibration block.
3. Put the calibration block on the pad so that the laser light rests in the center of the
cross-hair label on the calibration block, and the brass is on the bottom.
QA calibration block
1 Laser
2 Brass on bottom

4. Select OK, and follow the screen prompts to complete the QA procedure.
If the QA test did not pass, reposition the calibration block and repeat the
procedure.
If the procedure fails a second time, call GE Support for assistance.
5. To print the QA results (if the auto print option is not set) select Report. Keep
the QA printout for one year.
6. To trend the QA results, select Settings, choose Table or Graph, and select the
result that you would like to trend. Select OK.
Failures are represented by red dots on the graph.
Precision and Accuracy

Precision
Precision is the ability to repeatedly obtain the same BMD value. Precision error may
be reported as a standard deviation (SD) in g/cm2 or as a coefficient of variation (%CV)
which is defined as the SD / Mean BMD in percent.
The following table defines the expected precision error for most common DXA
measurements.
Site Precision (g/cm2) Precision (%CV ) Region of Interest
AP spine BMD 0.010 g/cm2 1.0% L1-L4 or L2-L4

Femur BMD 0.010 g/cm2 1.0% Dual Femur Total
Total body BMD 0.010 g/cm2 1.0% Total
Precision for other sites will range 1-3%. Precision may be affected by operator
technique and other variables associated with patient anatomy. See Cautions for DXA
Determinations (41) and Precision Calculator (181) for additional details.
AP Spine Thickness Dependence
The precision of BMD measurements over a soft tissue thickness range from 15 cm to
25 cm is less than or equal to 2% (%CV).
AP Spine Dependence on Height above Tabletop
The precision of BMD measurements over a 5 cm change in object plane is less than
or equal to 2% (%CV).
The printed DXA reports display a footnote indicating the precision error associated
with a measurement:
1 – Statistically 68% of repeat scans fall within 1SD (±0.010 g/cm2 for AP Spine L1-L4)
Accuracy
Accuracy indicates how close a measured value is to the actual value.
The Daily QA feature measures a standard black block which is supplied with
each scanner. The block consists of three chambers simulating BMD values of

approximately 0.500 g/cm2, 1.000 g/cm2, and 1.500 g/cm2. During Daily QA, the
BMD for each chamber is measured and checked that it is within 0.030 g/cm2 of
its expected value which ensures the linear correlation for BMD (R ≥ 0.99). At the
end of QA, the entire block is scanned to simulate an AP spine measurement and
the accuracy is checked again.
Navigate to QA > QA Trend Graphs to monitor QA trends for key values.
QA Controls
For more information about the QA GUI, refer to Quality Assurance Screen (235) and
Quality Assurance Toolbar (236).
For information about customizing the QA options, refer to QA Tab (249) in the Options
section.
Icon Item Description
Startup Test ● Database Validation
● Scanner Self-test
● QA Block Search
● Peaking
Mechanical Test ● Beam Stop
● Transverse Distance
● Longitudinal Distance
X-ray/Detector ● Spectrum Spillover

● Reference Counts
● Detector Status
Calibration ● BMD values of High, Medium and

Low block chambers
● Tissue values of Lean, Normal and
Fat block values
● Trend analysis
Phantom BMD, BMC, Area, Edge detection
Click the Trend tool to exit the QA process screen.
QA Trend Reporting Options

On the QA screen, click Settings. The settings screen provides many options for QA
trend reporting components.
In the upper right panel are options for the QA Report Type:
● QA Phantom Report
● Ancillary page

● Legacy QA Report
QA Phantom Report
QA Ancillary page

Legacy QA Report
Measure the Spine Phantom

The enCORE-based scanner does not require a separate Quality Control to be run
in addition to Quality Assurance. The daily QA procedure run on the scanner both
calibrates the machine and has “bone” chambers that are used for Quality Control
measurements. This removes the necessity of requiring a phantom to be measured
by the user for separate control measures. The phantom is considered a service
tool. Every system includes an aluminum spine phantom and water container. An
encapsulated phantom is available for purchase.
Water container (left) and encapsulated phantom (right)
A spine phantom baseline was performed with the installation of your scanner. This is
found in the patient database. For general use, use the same patient information that
was established with the spine phantom baseline scan.

For details on performing the scan, refer to AP Spine Measurement and Analysis (86).
1. Put 15 cm of water in the plastic container and position the aluminum phantom
in the middle of the plastic container.
2. Position the phantom so that L5 is toward the foot of the scanner.
3. From the Main screen, select Measure (F2).
4. Have you measured the phantom before?
a. If yes, select the phantom from the patient list and continue to step 7.
b. If no, continue to step 5 and 6 to record the information for the spine phantom.
5. Record the primary information in the dialog box:
Field Entry
First name Spine
Middle initial None
Last Name Phantom
Birth Date Record the current date minus 40 years.
For example, if today's date is September
28, 2011, type 09/28/1971. Do not
change this date for future spine phantom
measurements.
Height 67 inches or 170 centimeters
Weight 154 pounds or 70 kilograms
Sex Male
Ethnic Group White
6. Select the secondary tab and record the following information:
Field Entry
Comments Record the phantom number given on
the L5 region of the spine phantom. Also
record your System ID number. This
number is located in Tools > User Options
> System tab.
7. Select Position from the toolbar.

A graphic is shown illustrating the correct patient and laser position for the scan
type.
8. Position the laser cross-hair on the letter “R” in the word “LUNAR” on the L5
vertebral body of the phantom.

9. Start the scan.
10. When approximately half of T12 is imaged, select Abort from the toolbar.
11. Choose Save measurement from the Save dialog box and select OK if the
measurement was performed correctly.
12. For spine phantom analysis, it is necessary to verify and adjust accordingly for
the following vertebral heights:
L2: 3.00 cm +/- .02 cm
L3: 3.50 cm +/- .02 cm
L4: 4.00 cm +/- .02 cm
L2-L4 region height should be 10.5 cm
13. On the Analysis screen, select the ROI tool to view this information.


Measurement and Analysis
5
Measurement: Overview and Warnings
Patient Considerations
Obey these patient considerations before you start a patient measurement:
● Clothing restrictions: Make sure the patient removes items that can attenuate
the x-ray beam, such as clothing with zippers, snaps, buckles, and buttons. Ask
patients to wear a jogging suit to the exam or give them an examination gown
when they arrive.
● Radionuclide and radiopaque agents: Make sure the patient has not ingested or
been injected with radionuclides or radiopaque agents in the past 3 to 5 days. If
the patient has taken tests that use such agents, postpone the measurement until
all traces of the element have left the patient’s body. A 72-hour waiting period is
usually long enough for most agents to leave the patient’s body. However, consult
your radiation safety officer (RSO).
● Pregnancy restrictions: If it is necessary to measure a pregnant patient, the fetus
could be exposed to small amounts of radiation. Postpone the measurement until
the end of pregnancy if clinical management is not affected. The decision to
subject a fetus to radiation exposure must be made by the referring physician,
noting that 1) bone quality for most patients does not significantly change during
pregnancy and 2) in the advanced stages of pregnancy, the fetus’ mineralized bone
can interfere with measurements of the mother’s spine and femur.
● Metal devices: BMD estimates are difficult to interpret for patients with orthopedic
metal devices within the scan field.
Measurement Warnings
Each scanner is equipped with a Class II Laser that is less than 1 milliwatt in
strength. DO NOT STARE INTO THE BEAM.
Remove foam leg block prior to positioning scan arm over the patient and
immediately after completing an AP Spine scan.
Verify that the patient's head, arms, knees, and any other body parts are not
in direct path of a moving scan arm.

Measurement Modes
Patient thickness determines the appropriate measurement mode. The program
defaults to the appropriate mode based on the patient's height and weight. Default
scan parameters are recommendations to be applied directly to allow optimized
operation. The operator makes the final decision based on patient thickness before
starting the exam. The selection of measurement modes influences the patient
radiation exposure. For more information about radiation exposure and measurement
modes, refer to the section Current and Typical Dose Tables (307).
iDXA: Patient Thickness Limits for enCORE Measurement Modes
iDXA iDXA Forma
Site Mode Patient Patient thickness
thickness or or weight
weight
AP Spine Thick >25 cm >25 cm

Standard 13-25 cm 13-25 cm
Thin <13 cm <13 cm
QuickView >13 cm NA
Femur Thick >25 cm >25 cm
Thin <13 cm <13 cm
QuickView >13 cm NA
Thick - AFF >25 cm >25 cm
Standard - AFF 13-25 cm 13-25 cm
Thin - AFF <13 cm <13 cm
Total Body Thick >25 cm >25 cm
Thin <16 cm <16 cm
Small <9 kg (20 lb) <9 kg (20 lb)
APVA Thick >25 cm >25 cm
Thin <13 cm <13 cm
Orthopedic Hip Thick >25 cm >25 cm
Thin <13 cm <13 cm
LVA Standard >13 cm >13 cm
Thin <13 cm <13 cm
Lateral Standard All thicknesses All thicknesses

iDXA iDXA Forma

weight
Forearm Standard All thicknesses All thicknesses

Hand Standard All thicknesses All thicknesses
Orthopedic Knee Standard All thicknesses All thicknesses
iDXA: Small Animal Weight Limits for enCORE Measurement Modes

iDXA iDXA Forma
Mode Patient Weight Patient Weight
Small Animal Large >20 kg >20 kg
Medium 2.0-20.0 kg 2.0-20.0 kg
Small <2.0 kg <2.0 kg
Prodigy: Patient Thickness Limits for enCORE Measurement Modes

Prodigy, Prodigy Primo,
Prodigy Prodigy Forma
Pro, Prodigy
Advance
weight
AP Spine Thick >25 cm >25 cm
Thin <13 cm <13 cm
QuickView >13 cm NA
Femur Thick >25 cm >25 cm
Detail >13 cm NA
Thin <13 cm <13 cm
QuickView >13 cm NA
Thick - AFF >25 cm NA
Standard - AFF 13-25 cm NA
Thin - AFF <13 cm NA


Pro, Prodigy
Advance
weight
Total Body Thick >25 cm >25 cm
Thin <16 cm <16 cm
Small <27 kg (60 lb) <27 kg (60 lb) (N/A
on Primo)
APVA Thick >25 cm >25 cm
Thin <13 cm <13 cm
Orthopedic Hip Thick >25 cm >25 cm
Thin <13 cm <13 cm
LVA Standard >13 cm >13 cm
Lateral Standard All thicknesses All thicknesses
Forearm Standard All thicknesses All thicknesses
Hand Standard All thicknesses All thicknesses
Orthopedic Knee Standard All thicknesses All thicknesses
(N/A on Primo)
Prodigy: Small Animal Weight Limits for enCORE Measurement Modes

Pro, Prodigy
Advance
Mode Patient Weight Patient Weight
Small Animal Large >20 kg >20 kg
Medium 2.0-20.0 kg 2.0-20.0 kg
Small <2.0 kg <2.0 kg

DPX-Bravo/Duo: Patient Thickness Limits for enCORE Measurement Modes

Site Mode Patient thickness
AP Spine Thick >25 cm
Standard 15-25 cm
Thin <15 cm
Femur Thick >25 cm
Detail >15 cm
Standard 15-25 cm
Thin <15 cm
Orthopedic Hip Thick >25 cm
Standard 15-25 cm
Thin <15 cm
Lateral Standard NA
Forearm Standard All thicknesses
DPX-NT/MD+: Patient Thickness Limits for enCORE Measurement Modes

AP Spine Thick >25 cm
Standard 15-25 cm
Thin <15 cm
Femur Thick >25 cm
Detail >15 cm
Standard 15-25 cm
Thin <15 cm


Total Body Thick >25 cm
Standard 15-25 cm
Thin <15 cm
Orthopedic Hip Thick >25 cm
Standard 15-25 cm
Thin <15 cm
Lateral Standard All thicknesses
Forearm Standard All thicknesses
Measurement Procedures: Overview

This section describes the basic steps necessary to complete a patient measurement.
These steps must be completed in the order given. Review the steps before you start a
patient measurement.
1. Record or select patient information:
● Record information for a new patient (73), or
● Select a patient record from the database (72)
2. Select the measurement site:
● AP Spine (86)
● Femur/DualFemur (91)
● Forearm (110)
● Total Body (114)
● Lateral Spine (143)
● LVA Morphometry (147)
● LVA Spine Geometry (155)
● APVA Morphometry (158)
● APVA Spine Geometry (160)
● Dual VA (APVA and LVA in one scan) (163)
● Pediatric (163)
● Hand (167)
● Orthopedic Hip (170)
● Orthopedic Knee (174)
● Small Animal (177)
After measurement, continue with analysis (77).
Select Existing Patient Record

Select a patient for a new measurement from either the Main screen or the Directory
screen. Use the Search option (233) to find the patient, if necessary.
From the Directory screen

1. In the Patient list, highlight the patient and select Measure from the Common
toolbar.
The New Measurement screen is shown.
From the Main screen
1. Select Measure.
2. In the Patient Information dialog box, select Find.
3. Double-click the patient in the Patient list.
4. In the Patient Information dialog box, verify that the patient information is correct,
and then select OK.
The New Measurement screen is shown.
Record New Patient Information

1. Select Measure from the Main screen or New from the Directory toolbar.

2. Record the necessary information in the three tabs in the Patient Information
dialog box.
Patient Information dialog box
● Primary tab: You must record the patient’s name, birth date, height, and
weight to complete a patient measurement. Change the default gender or
ethnicity in the Tools > User Options > Directory tab > Directory Rules and
Defaults button.
● Secondary tab: The Secondary tab lets you record comments and
administrative information that is not required to complete a patient
measurement. If the ISCD guidelines are turned on under Tools > User Options
> Systems, it is important to enter a menopause age for postmenopausal
women because the WHO criteria are only applied to postmenopausal women
and men age 50 and older.
● Additional tab: The Additional tab lets you record fracture, indication, and
treatment information for the patient. The tab also allows you to assign ICD-9
or ICD-10 codes to each fracture, indication, and treatment applied to all
patients. In addition, you can enter the patient’s insurance information. This
information is not required to complete a measurement.

3. Select OK when you have finished recording the patient information.

When you attempt to add a new patient to the Directory, the system checks
whether the patient already exists. If the system finds potential duplicates, you
are prompted to either select an existing patient or to create a new patient.
Preventing duplicate patient records is important because a single patient record
is needed to trend a patient’s exam data over time.
You can configure your system to evaluate either the patient name, birth date and
patient ID or only the patient ID when checking for duplicates using Tools > User
Options > Directory tab > Directory Rules and Defaults button. Please see the
Directory Tab (241) section for more information.
If you started from the Main screen, the New Measurement screen is shown.
Proceed with the measurement.
If you started from the Directory screen, highlight the patient's name and select
Measure from the toolbar to open the New Measurement screen, and then
proceed with the measurement.
Select Measurement Site

The New Measurement screen shows a skeletal image of the sites you can select to
measure.
New Measurement screen
1. On the New Measurement screen, click the site you want to measure.
The site you select is highlighted in the Exam list.
2. Follow the measurement procedure for the site you selected.
Refer to Measurement Modes (68) for more information.
Abort Measurement
If the image is not correct, or if you determine that a sufficient area of the
measurement has been obtained, select Abort (F5) from the New Measurement
toolbar.
When you select Abort, the measurement stops automatically when the detector
reaches the edge of the scan window. A message shows these options:
● Resume Measurement Select this option to continue the measurement.
● Save Measurement Select this option to save the current measurement.

● Reposition this measurement and do not save the aborted measurement Select
this option to start the measurement again using the same settings. The box that
is shown around the image shows the measurement area. Use the arrow keys
to move the box and reposition the measurement. Select Start from the New
Measurement toolbar to restart the measurement.
● "Set up a new measurement and do not save the aborted measurement Select
this option to change the settings for the measurement.
OneVision
The OneVision feature allows you to set up multiple measurements in one exam. This
eliminates keystrokes and improves throughput for customers that routinely perform
multiple measurements on each patient. OneVision is required for DICOM or HL7
reporting interfaces. By default, the enCORE software includes the exam combinations
of AP Spine + DualFemur, AP Spine + DualFemur + LVA, and Dual VA (LVA + APVA). Exam
combinations are found at the top of the Exam list on the New Measurement screen.
The images included in the exam are displayed in a tab view.
When scanning with a series of OneVision scan types, select Next to proceed to the
next image site in the exam, or Repeat the current measurement. Refer to Basic
Measurement Procedures (72) for information about obtaining appropriate image
measurements.
Create Exam Protocols
You can create your own exam protocols with the OneVision feature.
1. Select Measure > Create Exams.
2. To create an exam protocol, select New.

You can also delete, rename, or edit existing exam protocols from the Create
Exam dialog.

3. Enter a protocol name in the box provided, then select OK.

It is recommended that you enter a name that describes either the images
included in the exam or a specific description of the exam.
After the protocol name is entered, define the measurement sites included in the
exam and the sequence of the measurements in the exam.
4. Select the image site from the available sites on the left, and select Add to add the
image site to the exam.
5. Use the Up and Down buttons to modify the sequence of image measurements
in the exam.
6. When finished, click OK.
QuickView
QuickView offers a fast, 10 second spine or femur scan. Measurement and analysis
procedures are the same as other scan modes.
The larger pixel width of QuickView results in reduced image resolution.
Standard scan modes provide optimal precision and are recommended for follow-up
scans to monitor changes in BMD.
For more details on the scan mode specifications, refer to Measurement Modes (68).
Analysis Procedures: Overview

This section describes the basic steps necessary to perform analysis of a completed
patient measurement (72). These steps must be completed in the order given. Review
the steps before you start analysis.
The results tabs for AP Spine, Femur, Forearm, and Total Body
images include a ScanCheck (183). Use the list of Yes/No
questions to assist in analysis. There is a space for comments.
You can print the checklist by selecting to print ScanCheck in
the Report Center.
1. Select an image (77)

2. Adjust the image (78)
● Advanced: Adjust ROIs (79)
● Advanced: Adjust point typing (79)
3. Complete analysis for the selected site.
Select Image
These basic steps apply to all images. For specific instructions about site analysis,
refer to the topic for the specific site (for example, AP Spine Analysis (89) or Femur/Dual
Femur Analysis (96)).
1. From the Main screen, click Analyze, select the image to analyze, and click OK.
Or, from the Directory screen, select the patient from the Patient list, select the
image to analyze, and click Analyze.
You can use the Search option to locate a patient in a large database.

2. Adjust the image as needed.

enCORE typically performs the analysis automatically. Do not change ROIs or
point typing unless the analysis shows an obvious need for corrections.
Adjust Image
After selecting an image (77), you can adjust it as needed.
1. Select Imaging from the Analyze toolbar to adjust the image:
The Image Tools window is shown.
2. Use this window to change the gray levels of the image and zoom the image.
The Image Tools window shows a bone profile and gives these options:
● Brightness: To adjust the brightness for the image, click and drag the
brightness scroll bar right or left.
● Contrast: To adjust the contrast for the image, click and drag the contrast
scroll bar right or left.
● ClearView: For LVA and iDXA AP Spine, Femur, and Forearm images, you can
adjust the sharpness. To increase or decrease the sharpness of the image,
move the arrow up or down the ClearView scale.
● Zoom: To zoom the image, use the bar to scroll through the percentage values.
Use the Pan tool if the image is larger than the window area on the Analyze
screen.
3. Click the Dialog Size icon in the lower left and select Advanced to adjust
Threshold, Range, Low/High Controls, or Image Type and to reset contrast.
4. Use these tools (shown on the Analyze screen (231)) to magnify an image during
analysis:
Icon Tool Description
Reset Mode Select to deactivate the Zoom and Pan

Image tools.
Zoom Image Select the Zoom Image tool to zoom in
or out on the image. Click the image to
zoom in, or click to zoom out.
Pan Image If you zoom the image larger than the
viewable area on the screen, use the
Pan Image tool to view hidden areas
of the image. Click the image and drag
the cursor to pan the image.
Zoom Slider Use the Zoom Slider to zoom the image
in or out

Advanced: Adjust ROIs

ROIs do not need to be adjusted in most circumstances. The procedures for adjusting
ROI position are specific to each measurement site.
Some ROI adjustments will render the results unreliable.
See the specific image type recommendations for analysis.
Advanced: Adjust Point Typing

Point typing is a tool that lets you view how the program classified the sample points,
and change the classification if necessary. The point typing determines the placement
of bone edges.
enCORE analysis automatically assigns point typing to an image and usually requires
no adjustment. Significant changes to point typing will affect both the results and
reproducibility of an image.
The procedures that follow give instructions to examine and adjust point typing for
an image.
Do not adjust the point typing unless the program has made obvious errors. Change
the point typing only if the area that needs to be changed is larger than the default
cursor size. It is recommended that changes be limited to Bone and Neutral point
typing.
1. Select Points from the Analyze toolbar.
The Point Type window is shown. The program automatically determines if a
sample is bone, tissue, neutral, air, or artifact:
● Bone: Verify that the bone is typed as Bone.
● Artifact: Foreign material to be excluded in analysis.
● Tissue: Tissue point typing is specific to each measurement site.
● Neutral: Select the Neutral brush type and verify that a thin border of neutral
samples is shown around the bone.
Neutral point typing is not available on Total Body scans.
2. To adjust point typing, select a brush type (Bone or Neutral) and a brush size.
3. Click on the image to make your changes.
4. If necessary, select the Artifact brush to point type an artifact in the image.
● To return the image to its original state, select Reset.
● To correct errors you make while adjusting the point typing, select Undo.

Examples of Correct Bone Point Typing

AP Spine correct bone point typing Femur correct bone point typing
Forearm correct bone point typing Lateral spine correct bone point typing
Examine Results
The Results tabs on the Analyze screen let you review BMD, reference, trend, and
composition results.
To change default settings for graphs, reference data, and results tables, refer to
Options (243).
Reference Graph
The reference graph provides a visual representation of the exam results compared
to a reference population. A patient's BMD, expressed in grams per centimeter
squared, is plotted against his or her age. The square with a black dot represents the
patient. Each colored bar below the dark green section represents one standard
deviation below the Young Adult value. The thin line separating the dark green from
the light green indicates a T-Score of –1. Following across, the patient’s T-Score can
be determined.
The T-Score indicates how many standard deviations a patient's BMD is from the
mean BMD value of the healthy Young Adult reference population. A negative T-Score

indicates the patient's BMD is below the Young Adult value. A positive T-Score
indicates the patient's BMD is above the Young Adult value.
T-Score
The blue bar displays the Age Matched Reference and demonstrates the change
in bone density associated with aging. The centerline of the blue bar is called a
regression line. The regression line shows the expected BMD at different ages for a
particular measurement site. The blue bar represents the expected Age-Matched BMD
± 1 standard deviation for a given patient.
Age-Matched Reference
enCORE factors in two variables which affect the regression line:

● Weight Adjustment: Body weight is moderately associated with BMD (r = ~0.3).
As weight increases or decreases, bone density generally increases or decreases
proportionally. For every kilogram of weight above or below the average weight
for men (78 kg) and women (65 kg), the expected BMD is adjusted by 0.004 for AP
spine BMD and 0.003 for femur BMD. This weight adjustment is applied for weights
between 25 and 100 kg. Weight adjustments are applied to age-matched values
(Z-Score) only. Young adult (T-Score) values are not affected. If the same patient
weighs 90 kg instead of 45 kg, the blue regression bar shifts upward while the
patient's BMD is unchanged. In other words, the age-matched weight adjustment
increased the patient's expected BMD. The Weight Adjustment option is turned on
or off in Tools > User Options > Reference Data.
● Ethnic Adjustment: The Ethnic Adjustment, like the Weight Adjustment, only
affects the age-matched regression bar. Young adult values are not affected. The
ethnic adjustment takes ethnic origin into consideration for the final age-matched
comparison. The program automatically shifts the age-matched regression bar
up or down according to ethnic origin if this option is turned on or off in Tools >
User Options > Reference Data.

enCORE may be configured to display the World Health Organization (WHO) or

Japanese Society for Bone and Mineral Research (JSBMR) bars in Tools > User Options
> Results Display tab > Reference Graph Options. This option labels the graph with
the different WHO or JSBMR classifications; Normal, Osteopenia, and Osteoporosis.
Reference Results
Use of the reference population comparisons is fully at the discretion of the clinician.
The program does NOT show the comparative reference values when shipped from
GE Healthcare.
Reference results include the reference graph and reference results table:
● Reference graph: Select the Densitometry Results tab to view the reference graph.
The Reference graph shows the patient's T-Score and Z-Score results.
● Reference results table: The results table shown below the Reference graph
gives the results for each region analyzed. To view the results for a region on the
Reference graph, highlight the region.
BMD values should be considered together with other risk factors (low body
weight, fracture history, corticosteroid use, use of long-acting tranquilizers, history
of falling) in the patient evaluation. In particular, patients with a prior history of
osteoporotic fracture should be considered to have double the risk of future
fracture at any density level.

Patient Trending
enCORE provides a monitoring tool to view changes in a patient's BMD over time. To
view trending results, 1) all of the trended measurements must be from the same site,
and 2) each trended measurement must be analyzed.
Scans with mixed positioning and/or analysis may not be trended together on all
graphs.
Trending Graphs
Select the Trend Results tab to view patient trending information.
Each measurement is shown as a separate square on the graph. A dot is shown
in the square that represents the current image. Trend graphs can be configured
as percent change or reference.
To change the graph display, go to Tools > User Options > Trending tab. Refer to
Options (236) for information about configuring User Options.
Scans with mixed positioning and/or analysis may not be trended together on all
graphs. Reference Only Trend Graphs (enabled in Tools > User Options > Results
Display tab > Reference Graph Options button > Graph section) allow mixed analysis
or positioner exams on the same trend graph (no BMD dependency).
Percent Change Trend Graph

Reference Trend Graph (BMD and reference)
Reference Only Trend Graph (no BMD dependency)
Trending Results Table

The trending results table is shown below the trending graph. The table gives the
date of the measurement, the patient's age, the BMD for the measurement, and
the change in BMD.
Trending information is shown for the region highlighted in the Densitometry table. To
change the region, highlight a new region and select the Trend tab.

OneScan
OneScan performs an AP Spine and DualFemur exam without repositioning between
scans. OneScan does not use the foam leg block positioner for spine positioning.
Turning OneScan On and Off

The OneScan option can be defaulted on or off through Tools > User Options >
Measure tab.
A pause may be enabled to occur between femurs (DualFemur) or between AP Spine
and Femur scans. See OneScan Measurement (85).
The Position screen also includes a OneScan checkbox. If this is selected, and the
patient has had a previous scan, the software will auto-select the matching OneScan
option for trending.
Determine if the OneScan feature was on or off through examination of the analysis
screen under the Information tab.
OneScan Measurement
The positioning graphics are tied directly to the configuration of the OneScan check
box.
OneScan is intended to be used without the leg block.
The screen changes slightly, depending upon whether the OneScan box is checked.
OneScan on OneScan off
If you are using OneScan, position the patient as follows:

1. Help the patient onto the scanner table and position the patient in the center
of the scan table.
2. Use the centerline on the table as a reference to align the patient. The patient's
arms should be crossed over the chest, away from the side of each hip.
3. Align the centerline on the scanner table with the guide on the base of the foot
brace.

4. Internally rotate the patient's legs, and secure the patient's feet to the foot brace.
It is suggested that you do not remove the patient’s shoes.
During a combined AP Spine and DualFemur (or single femur) measurement, the
software immediately proceeds to the femur setup. With the OneScan feature
enabled, the software proceeds directly to the positioning screen for adjustment
of the laser light position. The OneScan feature eliminates this pause, as the
patient is already positioned with their feet in the DualFemur brace for femur
measurements.
A pause may be enabled between scans. This option is found in Tools > User
Options > Measure tab. Check the desired options.
AP Spine Measurement and Analysis

AP Spine measurement and analysis provides an estimate of bone mineral density
for the lumbar spine. These values can then be compared to an adult reference
population at the discretion of the physician.
AP Spine Measurement
The positioning requirements for an AP Spine measurement depend on whether you
have chosen OneScan in Tools > User Options > Measure tab.
● If OneScan is checked for a specific measurement, do not use the foam block
positioner.
● If OneScan is not checked for a specific measurement, be sure to use the foam
block positioner.
For OneScan measurements, the T-Score calculation assumes the foam block is not
used.
1. Position the patient.
If you are using the foam leg block positioner:
a. Help the patient onto the scanner table and position the patient in the center
of the scan table.
b. Use the centerline on the table as a reference to align the patient.
The patient's arms should be on the scanner table, alongside the patient's
body.

Remove the foam leg block prior to positioning the scan arm and
immediately after the AP Spine scan.
c. Select Position from the New Measurement toolbar.

The scanner arm moves to the approximate start position, and a graphic is
shown that gives the correct patient position and measurement start position.
d. Use the foam leg block to elevate the patient's legs. Make sure the patient's
thighs form a 60° to 90° angle with the table top. This step helps separate
vertebrae and flatten the lower back.
If you are not using the foam leg block positioner (OneScan):
a. Help the patient onto the scanner table and position the patient in the center
of the scan table.
b. Use the centerline on the table as a reference to align the patient.
The patient's arms should be crossed over the chest, away from the side of
each hip.
c. Select Position from the New Measurement toolbar.

The scanner arm moves to the approximate start position, and a graphic is
shown that gives the correct patient position and measurement start position.
d. Use the centerline on the scanner table as a reference to make sure the foot
brace is centered.
e. Align the centerline with the guide on the base of the foot brace. Internally
rotate the patient's legs, and secure the patient's feet to the foot brace (it is
recommended that you do not remove the patient's shoes).

2. Select the appropriate scan mode based on the thickness of the AP Spine area.
The scan mode for the AP Spine may be different than the scan mode used for
the femur, based on the patient's weight distribution.
3. Adjust the position of the laser light. Position the laser light approximately 5 cm
below the patient's navel and in the same longitudinal plane as the patient's
midline.
4. To start the measurement, select Start from the New Measurement toolbar
5. Monitor the image to make sure it is correct. Make sure that:
● The spine is in the center of the image
● (1) All of L4 (1) is shown
● (2) The top of L5 (2) is shown in the first 1-2 sweeps for iDXA and Prodigy
scanners
● (2) The top of L5 (2) is shown in the first 5-15 scan lines for DPX scanners
● (3) Approximately 1/2 of T12 is shown

6. If the image is not correct, select Abort, reposition the laser light, and restart
the measurement.
7. To complete another measurement for the patient, select Set Up from the New
Measurement toolbar.
8. If you have completed measurements for the patient, select Home to move the
scanner arm to the Home position
9. Select Analyze to proceed to Analysis, or Close to exit the Measurement screen.
AP Spine Analysis
1. If an image is not already open, select an image file for analysis.
The results may include a ScanCheck tab. Use ScanCheck
(183) to assist in the analysis of the image and to help you
make corrections where necessary.
2. If necessary, select Imaging from the Analysis tool bar to adjust the image.
3. If necessary, select ROIs from the Analyze toolbar to adjust the ROIs.
enCORE software will place the ROIs correctly most of the time. Do not make
adjustments to the analysis unless there is an obvious adjustment needed.
Make sure vertebrae are correctly identified and intervertebral (IV) markers are
between the vertebral bodies (1) and located at the lowest point of bone density
as indicated on the bone profile (2).
Analysis results
4. If you need to adjust ROIs for an AP Spine image, use these tools:
Add ROI Select Add ROI to add an ROI during AP Spine
analysis. When you add a new ROI, it is inserted
below the ROI that is selected on the image.
Select Label ROI to label the ROIs accordingly.
Delete ROI Select Delete ROI to remove an ROI during
AP Spine analysis. Click the ROI, then select
Delete ROI. Select Label ROI to label the ROIs if
necessary.


Move ROI Select Move ROI to move ROIs.
Rotate ROI Select Rotate ROI to rotate an ROI.
Label ROIs Select Label ROIs to relabel ROIs after you have
added or deleted an ROI from an image.
Exclude ROIs This tool lets you remove ROIs from AP spine
results.
Select Exclude ROI, and then select the ROIs
you want to exclude from analysis. Parentheses
appear around the ROI labels of excluded ROIs.
Results for individual ROIs are shown even if the
ROIs are excluded from analysis. Excluded ROIs
are not included in the results for combinations
of vertebrae.
Show/Hide ScanCheck This tool lets you show/hide ScanCheck markers
Markers that indicate a possible high density area, such
as an artifact or osteophyte.
ScanCheck Markers is available only if ScanCheck
is enabled.
5. If you adjust ROIs, select Results to view the analysis results.

6. If you need to adjust point typing, select Points from the Analyze toolbar.
Do not adjust the point typing unless the program made obvious errors.
7. If you adjust point typing, select Results to view the new analysis results based
on your changes.
Bone points Neutral points Tissue points
8. Select Save to save your changes, or select Close then No if you do not want
to save your changes.
Refer to Custom Analysis Procedures (180) and Estimated Total Body Fat and
Android/Gynoid Fat (129) for additional analysis information.

Femur/DualFemur Measurement and Analysis

Femur/Dual Femur measurement and analysis provides an estimate of bone mineral
density for the proximal femur. These values can then be compared to an adult
reference population at sole discretion of the physician.
Femur/DualFemur Measurement
1. Help the patient onto the scanner table and position the patient in the center of
the scan table. Use the centerline on the table as a reference.
each hip.
2. Select Position from the New Measurement toolbar.

The scanner arm moves to the approximate start position, and a graphic is shown
that gives the correct patient position and measurement start position.
3. Use the centerline on the scanner table as a reference to make sure the foot brace
is centered. Align the centerline with the guide on the base of the foot brace.
Internally rotate the patient's legs, and secure the patient's feet to the foot brace
(it is recommended that you do not remove the patient's shoes).
4. Select the appropriate scan mode based on the thickness of the femur area.
The scan mode for the femur may be different than the scan mode used for the
AP Spine, based on the patient's weight distribution.

5. Adjust the position of the laser light. Position the laser light approximately 7-8 cm
below the greater trochanter where the transverse (Pubic Symphysis) and midline
of the femur intersect.
If you are performing a DualFemur measurement, position the laser light for
the left femur first.
● The Femur image shows the greater trochanter (1), femoral neck (2), and
ischium (3).
● A minimum of three centimeters of tissue should be shown above the greater

trochanter and below the ischium.
the measurement.
9. If you are performing a DualFemur measurement:
DualFemur lets you measure the patient's left and right femur in an automatic
sequence. After the program has measured the left femur, the scan arm moves
to the approximate start position for the right femur.
Check the start position and, if necessary, adjust the measurement start position
for the right femur.
10. DPX-Duo and DPX-Bravo have a narrow scan region. Therefore, repositioning the
patient for the contra-lateral femur may be necessary.

Atypical Femur Fracture Measurement

If you purchased the Atypical Femur Fracture (AFF) option for your bone densitometer,
AFF features appear in the enCORE software.
AFF measurement and analysis provides an x-ray image of the entire femur for both
qualitative visual assessment and quantitative measures in order to identify areas of
focal thickening along the lateral cortex of the femoral shaft. You can also get bone
mineral density values for the proximal femur of the AFF measurement.
1. Help the patient onto the scanner table and position the patient in the center of
the scan table. Use the centerline on the table as a reference.
each hip.

3. Use the centerline on the scanner table as a reference to make sure the foot brace
is centered. Align the centerline with the guide on the base of the foot brace.
Internally rotate the patient's legs, and secure the patient's feet to the foot brace
(it is recommended that you do not remove the patient's shoes).
4. Select the appropriate scan mode based on the thickness of the femur area.
The scan mode for the femur may be different than the scan mode used for the
AP Spine, based on the patient's weight distribution.

5. Adjust the position of the laser light. The laser light position for a femur
measurement depends on whether you have chosen to perform distal and
proximal scans for AFF.
For AFF measurements of both the distal and proximal femur, position the laser
light so it is centered on the patella.
If you are performing a DualFemur measurement, position the laser light for the
left femur first.
● The Femur image shows the greater trochanter (1), femoral neck (2), and
ischium (3).

● A minimum of three centimeters of tissue should be shown above the greater

trochanter.
the measurement.
9. AFF measurements are performed as a sequence of two exposures. After the
program has measured the distal femur, a prompt is displayed to start the
measurement of the proximal femur.
10. If you are performing a DualFemur measurement:
DualFemur lets you measure the patient's left and right femur in an automatic
sequence. After the program has measured the left femur, the scan arm moves
to the approximate start position for the right femur.
Check the start position and, if necessary, adjust the measurement start position
for the right femur.

Femur/DualFemur Analysis
When you open a DualFemur image for analysis, the left and right femur images
are both shown. The active femur has a blue box around its image window. Click
inside an image window to make that femur image the active image. The results
include BMD values for each region of each femur and averages and differences
between femurs. Reference data and trending are available.

2. If necessary, select Imaging from the Analyze toolbar to adjust the image.
3. If necessary, select Points from the Analyze toolbar to adjust point typing.
4. If you adjust point typing, select Results to view the analysis results based on
your changes.
5. Generally, no adjustments are necessary to ROI placement.
Do not adjust (move, rotate, or size) the Neck ROI unless it is obviously incorrect.
The Neck ROI should be positioned as follows:
● The Neck ROI includes no part of the greater trochanter
● The Neck ROI includes soft tissue on either side of the neck
● The Neck ROI is perpendicular to the femoral neck
● The Neck ROI contains little or no ischium (if the ischium is included in the Neck
ROI, the program automatically assigns the bone within the ischium as Neutral)

It is not recommended that you adjust the Neck ROI.

a. If it is necessary to perform further adjustments, select the ROI tool from the
Analysis toolbar to complete these procedures:
● Select the Search tool to position the neck ROI correctly. Search locates the
region of the lowest BMD and most narrow area of the neck.
● Move: Use the cursor to select and move the Neck ROI and the Neck Axis.
● Rotate: Use the cursor to select and rotate the Neck ROI and the Neck Axis.
● Size: Select the Size tool. Use the cursor to include tissue on either side of
the neck if none is present. Never edit the Neck ROI width.
6. Select Results to view the analysis results.

7. Select Save to save changes.
Refer to Estimated Total Body %Fat and Android/Gynoid %Fat (129), Advanced
Hip Analysis (106), or FRAX 10-Year Fracture Risk (97) for additional analysis
information.
FRAX 10-Year Fracture Risk
FRAX 10-Year Fracture Risk provides an estimate of 10-year probability of hip fracture
and 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip, or
shoulder fracture) for men and post-menopausal women ages 40-90 years.
This estimate is based on the patient’s age, gender, population, ethnicity, height,
weight, femur neck BMD T-score, and the presence or absence of several risk factors. It

is computed using the FRAX model endorsed by the World Health Organization (WHO).
T-scores are based on the NHANES reference values for women aged 20-29 years.
The physician should review local clinical guidelines, and then determine the optimal
FRAX configuration.
FRAX is a trademark of the University of Sheffield Medical School, Centre for Metabolic
Bone Diseases, A World Health Organization (WHO) Collaborating Centre.
Enabling and Configuring FRAX
To enable FRAX, select Tools> User Options > System tab and click FRAX.
FRAX dialog
Configure FRAX according to site needs. You can choose to:

● Always calculate a patient’s fracture risk (check Enable FRAX)
● Calculate FRAX according to NOF/ISCD recommendations (check Enable FRAX and
Apply U.S. NOF/ISCD FRAX Recommendations)
● Never calculate FRAX (clear both check boxes)
The default is both boxes unchecked.
FRAX 10-Year Fracture Risk Calculation
The FRAX tab is available during Left Femur, Right Femur, and DualFemur analysis.
Refer to this figure when following the steps below to calculate FRAX 10-Year
Probability of Fracture.

FRAX risk calculation
1. Check the appropriate risk factors, according to these guidelines:

Risk Factors Select risk factor if the patient:
Alcohol (3 or more units Takes 3 or more units of alcohol daily. This is
per day) equivalent to a standard glass of beer (285 ml), a
single measure of spirits (30 ml), a medium-sized
glass of wine (120 ml), or 1 measure of an aperitif
(60 ml)
Family Hist. (Parent hip Has a history of hip fracture in the patient's
fracture) mother or father
Glucocorticoids Is exposed to oral glucocorticoids or has been
(Chronic) exposed to oral glucocorticoids for more than 3
months at a dose of prednisolone of 5 mg daily or
more (or equivalent doses of other glucocorticoids)
History of Fracture Has a previous fracture in adult life occurring
(Adult) spontaneously, or a fracture arising from trauma
which, in a healthy individual, would not have
resulted in a fracture
Secondary Osteoporosis Has a disorder strongly associated with
osteoporosis. These include type I (insulin
dependent) diabetes, osteogenesis imperfecta in
adults, untreated long-standing hyperthyroidism,
hypogonadism or premature menopause (<45
years), chronic malnutrition, or malabsorption and
chronic liver disease
Rheumatoid Arthritis Has a confirmed diagnosis of rheumatoid arthritis
Tobacco User (Current Currently smokes tobacco
Smoker)

2. Check the appropriate NOF/ISCD Filters, according to these guidelines:

NOF/ISCD Filters Description
On Treatment Examples of “On Treatment” patients include:
● Estrogen/Hormone Therapy or SERM within the
past one year
● Calcitonin within the past one year
● Parathyroid Hormone (PTH) within the past one
year
● Denosumab within the past one year
● Bisphosphonate within the past two years
(unless it is an oral taken for <2 months)
Calcium and vitamin
D do NOT constitute
“On Treatment” in this
context.
Previous Fracture (Hip Prior hip or vertebral fracture (clinical or

or Spine) morphometric).
3. DualFemur measurements automatically select the region (Left or Right) with the
lowest femoral Neck BMD (lowest). You can change this selection by clicking on
the region of choice (Left, Right, or Mean).
4. Select the appropriate FRAX Population from the drop down menu. If the patient's
country is not represented, select the country for which the epidemiology of
osteoporosis most closely approximates the patient's country.
Based on the FRAX model, examples of high risk countries are Denmark and
Sweden. Low risk countries include Lebanon and China.
5. Click the Calculate button.
The 10-year probability of hip fracture and 10-year probability of a major
osteoporotic fracture are displayed.
FRAX 10-Year Fracture Risk Reports
The following FRAX 10-Year Fracture Risk reports are available:
Composer FRAX
DXA reports DualFemur FRAX, Left Femur FRAX, and Right Femur FRAX
(availability based on open exam).
Refer to Creating a Report (193) and DXA Results Reports (191) for more information
on generating reports.
Atypical Femur Fracture Analysis
Atypical Femur Fractures (AFFs) are stress fractures that occur in the femur shaft and
may be accompanied by a focal or diffuse periosteal reaction of the lateral cortex
surrounding the region where the fracture initiated. An area of cortical thickening is
called a “beak”, and the process of the thickening is called “beaking”.
Atypical Femur Fracture (AFF) Analysis displays an image of the entire femur to allow
the user to visualize focal reaction or thickening of the lateral cortex. In addition, the
software displays quantitative measurements of the cortical width along the femur
shaft, providing the user tools for measuring the size of the cortical width and beak.
These results are available for full length femur images by default. To enable AFF
results for proximal only images, go to Tools > User Options > Analyze tab > Femur
Analysis Options.
When the AFF tab is selected, the lateral and medial cortical bone edges are
highlighted on the image. The cortical width is measured and lateral cortex is analyzed
to locate an area of focal thickening. If a thick area is found, the beak is measured in
millimeters and an arrow points to its location.
Tools are provided to allow the user to inspect cortical widths along femur shaft.
The size of a beak is dependent on its orientation in a two-dimensional DXA
image. The user must use the foot brace to control leg position and can verify
rotation by looking at the prominence of the lesser trochanter on the DXA
scan image. The standard deviation of a beak size measurement is expected
to be 0.5 mm with consistent patient positioning. Clinical measurement
error may vary.
See Appendix G – AFF Phantom Study Results (457).

AFF image (beak identified by arrow):
AFF results
The following AFF results are available on the AFF results tab:
Beaking Index Magnitude of the increase in the cortical width at the location
of localized periosteal reaction in mm
Beaking Index is measured as the distance from inner cortical wall (A) to outer edge of
beak (B) minus the width of cortical wall in areas adjacent to beak (C) in mm.
The first time any exam with Femur AFF is analyzed, the user will be prompted to enter
a threshold to display an arrow where maximum beaking index is located. The arrow
will only appear on the image if the beaking index is greater than this threshold. The
threshold can be adjusted at any time in User Options > Analyze > Femur Analysis
Options.
AFF graphs
The following AFF parameters can be graphed on the AFF results tab:
Beaking Profile Profile along the femoral shaft of the beaking index in mm
Lateral Cortical Width Profile along the femoral shaft of the lateral cortical width
in mm
Medial Cortical Width Profile along the femoral shaft of the medial cortical width
in mm
Sample graph 1 - Beaking Profile graph
Sample graph 2 - Lateral Cortical Width graph
Sample graph 3 - Medial Cortical Width graph
AFF results are found on the AFF Report and Composer field codes are available. See
Create a Report (193) and DXA Reports (191) for more information on generating
reports.
AFF Trending Options

AFF parameters can be trended on the AFF tab.
Beaking Index trend graph
● From the Display drop-down menu, choose Trend: Absolute Value.

● From the Value menu, choose a value to trend.
● If you select Beaking Index for the trend value, each measurement is shown as a
separate square on the graph.
● Other values are shown as profiles of the selected value along the femoral shaft on
the graph. Each measurement is displayed in a different color.
Beaking Profile trend graph
AFF trending results table

The trending results table is shown below the trending graph. The table gives the date
of the measurement, the patient's age, and the beaking index.
Advanced Hip Analysis

The values computed by the Advanced Hip Analysis (AHA) software option are used to
estimate the structural properties of the hip. The values are not for clinical diagnosis
of a disease.
Advanced Hip Assessment (AHA) results are available for Femur and DualFemur
reports. AHA results include upper neck region, lower neck region, hip axis length
(HAL), and hip strength results. AHA is a purchased software feature.
Go to Tools > User Options > Analyze tab > Femur Analysis Options to enable these
options.
AHA includes all the standard femoral regions of interest previously available. In
addition, AHA provides a measurement of new regions of interest: upper and lower
femoral neck, automated determination of hip axis length, and hip strength values.
AHA image
1. Lower femoral neck

2. Trochanter
3. Ward's
4. Shaft
5. Total hip (defined as the combined region of the femoral neck, trochanter, and
shaft regions
6. Upper femoral neck
7. Hip axis length (HAL)
Hip Axis Length (HAL)

Hip axis length (HAL) provides a mean value of HAL for Caucasian and Asian females
on femur images.
HAL can be found on the AHA tab under the Hip Axis Length Comparison chart.
HAL image
AHA tab
Upper Neck and Lower Neck Regions

Upper Neck ROI (indicated in red on the image below) includes the bone above the
neck axis line. This region is automatically determined by the software based upon the
Neck ROI position and the calculated neck axis position.
Upper Neck ROI
Upper Neck reference data: Comparison to reference data is available for the
Upper Neck region. Femur upper neck reference data is available for both males
and females for the following reference populations: USA, Germany, Australia, UK,
Brazil, and Finland. Both young adult and age-matched results are displayed for
Upper Neck. Age-matched adjustments are provided for weight and ethnicity for all
supported populations. The Upper Neck region can be found immediately below
Neck in the region table.
Upper Neck reference data
Lower Neck ROI (indicated in red on the image below) includes the bone below the
neck axis line. This region is automatically determined by the software based upon the
Neck ROI position and the calculated neck axis position.
Lower Neck ROI
Hip Strength
Hip Strength provides an index of hip strength by combining BMD, femur geometry,
age, height, and weight.
Hip Strength image
The Hip Strength Index is derived from published information from the Journal of
Bone Mineral Research 1994 article entitled Geometric Structure of the Femoral
Neck Measured Using Dual-Energy X-ray Absorbitometry. The value is not for clinical
diagnosis of disease.
Hip Strength definitions
Strength Strength / stress, where
Index strength = 185 - 0.34(age - 45); Age > 45 years
stress = moment * y / CSMI + force / CSA
moment = d1 * 8.25 * weight * 9.8 (height / 170)1/2 * cos(180° - θ)
force = 8.25 * weight * 9.8 * (height / 170)1/2 * sin(180° - θ)
Buckling y/Cortical Width Neck
Ratio
Section CSMI/y
Modulus
(mm3)
CSMI Cross-sectional moment of inertia
CSA Cross-sectional area
d1 Distance from head center to section of minimum CSMI along neck
axis
d2 Distance along the neck axis from the center of the femoral head to
the neck/shaft axis intersection
d3 Average diameter of the femoral neck
y Distance from the center of mass to the superior neck margin
Alpha (α) Angle of shaft axis with respect to vertical
Theta (θ) Angle of the intersection of the neck and shaft axes
Hip Geometry
Hip Geometry provides information about the structural geometry of the femur.
Hip Geometry image
Hip Geometry definitions

Cortical width neck (mm) Cortical bone thickness of neck region
Cortical ratio neck (%) Ratio of cortical thickness to bone width of the neck region
Cortical width calcar (mm) Cortical bone thickness of calcar region
Cortical ratio calcar (%) Ratio of cortical thickness to bone width of the calcar region
Cortical width shaft (mm) Cortical bone thickness of shaft region
Cortical ratio shaft (%) Ratio of cortical thickness to bone width of the shaft width
Neck/shaft angle (deg) Angle of the intersection of the neck and shaft axes
Min neck width (mm) Width of narrowest part of femoral neck
Forearm Measurement and Analysis

Forearm measurement and analysis provides an estimate of bone mineral density
for the distal forearm. These values can then be compared to an adult reference
Patients can be positioned in either the seated or non-seated position on Prodigy
and iDXA systems.
Forearm Measurement
1. Put the forearm positioner on top of the pad.
The LUNAR logo should be located near the patient's fingers. The forearm
positioner keeps the patient's forearm from moving during a measurement.
2. Seat the patient in a chair next to the scan table.
Use a chair without arms or wheels. Use the same chair for all forearm
measurements to get optimal precision.
iDXA and Prodigy scanners have an option to scan the patient in a non-seated
position with the scan positioner under the forearm (Tools > User Options >
Measure tab). Continue to use the same method of positioning. If previous scans
were done in a seated position, continue to use the same scanning method to
trend data.
3. Place the arm on the positioning board with the palm down with the hand near
the Lunar label (1), and tell the patient to make a loose fist.
4. The red line (2) shows the center of the measurement area. Center the patient's
forearm along this line.
5. The black lines (3) show the boundary of the measurement area. Position the
patient's forearm so that both the radius and the ulna are between these lines.
6. The blue line (4) shows the starting point of the measurement. Position the
patient's forearm so the distal end of the ulna is at this line. This is where you will
position the laser light when you start a measurement.
7. Attach the Velcro straps over the fist and over the arm immediately below the
elbow.
The straps must be outside the measurement region.

that gives the correct patient position and measurement start position. Be careful
that the scanner arm does not bump the patient's head.
9. Use the graphic shown on the New Measurement screen to adjust the position
of the laser light. Position the Laser Light in the center of the wrist, adjacent
to the ulna styloid.
If necessary, move the positioner and the patient's arm so that the laser light
shines in the center of the patient's arm and is aligned with the blue line on the
forearm positioner.
Make sure the patient's elbow makes a 90-degree angle, and make sure the
forearm positioner is straight on the table top. All of the ulna styloid should be
visible.
● The forearm bones are centered and straight
● The forearm is in the center of the image
● The distal end of the ulna (1) is shown near the top of the image
the measurement.
15. Select Analyze to proceed to analysis or Close to exit the Measurement screen.
Forearm Analysis
2. If necessary, select Imaging from the Analyze toolbar to adjust the image.
3. If necessary, select ROIs from the Analyze toolbar to adjust ROIs.
4. Make sure the forearm ROIs are positioned correctly as follows:
● (1) The Reference line is located at the distal tip of the ulna styloid process
● (2) The UD ROI does not contain the radial endplate
● (3) The vertical lines in the center of the UD and 33% ROIs are located between
the radius and ulna
Forearm ROI positioning
Do not make any changes to the locations of the ROIs unless the program made
obvious errors.
5. Select Length, and make sure the length of the patient’s forearm is correct.
6. Select the Move/Size ROI tool or the Rotate ROI tool and move the Reference Line
to the correct location. All the ROIs move when you move the Reference Line.
7. If the radial endplate is included within the UD ROI, move the UD ROI to just
proximal to the endplate.
8. If you adjust ROIs, select Results to view the analysis results based on your
changes.
on your changes.
11. Select Save to save changes, or select Close then No if you do not want to save
changes.
Total Body Measurement and Analysis

Total Body measurement and analysis provides an estimate of bone mineral density
for the entire body. These values can then be compared to an adult reference
Total Body Measurement

Make sure all attenuating materials (belts, metal buttons, etc.) are removed from the
measurement region. For Total Body scans, all materials that may cause significant
attenuation must be removed. CoreScan results require the abdominal region must
not have tight waistbands and be completely free of all metal. Do not use thick
blankets or pads. Thick blankets, padding, or pillows can interfere with the scan and
cause shifts in results.
1. Remove the patient’s shoes.
3. Help the patient onto the scanner table and position the patient as follows:
A) The patient’s body is in the center of the scanner table. Use the centerline on
the table as a reference to align the patient.
If a patient is wider than the scan area, the patient can
be positioned for a half body scan (also known as a
MirrorImage scan). In addition to all of the right side of
the body, the entire head and spine should be included
in the scan window.
B) The patient’s hands are turned on sides with thumbs up, palms facing legs and
arms are alongside the patient’s body. If possible, hands should not touch legs.
CoreScan results require that hands do not touch legs and there is a small air gap
(~1 cm) between the arms and torso. Verify that the patient’s arms are within the
scan area lines on the table pad. This hand position will yield optimal results,
especially on heavier patients. Use of this hand position every time the patient
undergoes a Total Body measurement will lead to more consistent results when
trending the patient’s Total Body measurement data over time.
C) Velcro strap.
4. Make sure the patient’s head is approximately 3 cm below the horizontal line
on the table pad.
5. Use the Velcro straps to secure the patient’s knees and feet to prevent movement
during the measurement.
You are not required to adjust the scan arm position for
Total Body measurements.
7. Monitor the image to make sure it is correct.

A correct Total Body image shows the patient's entire body. Make sure the head
(1), feet (2), and arms (3) are shown in the image.
Correct total body image
8. If the image is not correct, select Abort and reposition the patient.
scanner arm to the Home position.
Total Body Analysis

Both the bone and soft tissue images are shown when you open a total body
image for analysis. Changes you make to the cut positions on one image are also
made on the other image. You can turn off the dual image option in Tools > User
Options > Image tab. Refer to User Options (236).
2. Select Imaging and adjust the image if necessary.
Total Body Cuts

Total body cuts
1. Head: The Head cut is located immediately below the chin.

2. Left and right arm: Both arm cuts pass through the arm sockets and are as close
to the body as possible. Ensure the cuts separate the hands and arms from the
body. CoreScan results require the arm cuts are in the middle of the air gap.
3. Left and right forearm: Both forearm cuts are as close to the body as possible
and separate the elbows and forearms from the body. CoreScan results require
the forearm cuts are in the middle of the air gap.
4. Left and right spine: Both spine cuts are as close to the spine as possible without
including the rib cage.
5. Left and right pelvis: Both pelvis cuts pass through the femoral necks and do not
touch the pelvis.
6. Pelvis top: The Pelvis Top cut is immediately superior to the iliac crests.
7. Left and right leg: Both leg cuts separate the hands and forearms from the legs.
8. Center leg: The Center Leg cut separates the right and left leg.
Adjust Total Body Cuts
1. Select the ROI tool from the Analysis toolbar.
2. If needed, select the Move Vertex tool to position ROI vertices or cuts.
3. Adjust the cut itself or select a vertex to adjust the cut position.
5. Select Save to save changes, or select Close and then No if you do not want
to save changes.
Left Total/Right Total Regions

The option to generate total left and total right regions is located in Tools > User
Options > Analysis tab. Check the option box to enable Left/Right Total Body results.
Half Body/MirrorImage Scan to Estimate Total Body
For very wide patients that do not fit within the scan boundaries it is recommended
that the analysis of half of the body be done.
In the example below, only the entire right half of the body fit into the scan area.
Half Body/MirrorImage scan image
Click the Estimate tool to estimate one side of the body from the other.
Total Body Densitometry Reference Graphs
If NHANES 1999-2004 is selected for the Total Body reference population on the
Reference Data Tab (244) in User Options, the NHANES Total Body Densitometry
reference graph is displayed as shown below.
The NHANES Densitometry Reference Graph Options dialog lets you change the
NHANES Densitometry reference graph breakpoints and colors. Access these options
in Tools > User Options > Results Display > Reference Graph Options > NHANES
Total Body.
Results can be set to Z-Score or Centile. There are two sets of editable graph
breakpoints and colors, one for each result type. Select Z-Score or Centile to see a
color control dialog where you can adjust the settings for that result.
The Breakpoints color control has three options:
1. Add/Shift: Add a breakpoint by moving the mouse to an open area between
existing breakpoints. When the pointer changes to a plus sign, click to add a
new breakpoint.
In Centile mode, the range of breakpoints that can be added is 1 to 99, in whole
number increments. In Z-Score mode, the range is -4.0 to +4.0, in 0.1 increments.
Shift (move) an existing breakpoint by moving the pointer to an existing
breakpoint. When the pointer changes to an arrow, drag the selected breakpoint
to the desired level.
When moving breakpoints, you cannot move it past a neighboring breakpoint.
2. Delete: Delete a breakpoint by moving the pointer to an existing breakpoint.
When the pointer changes to an X, click to delete the selected breakpoint.
You must have at least one breakpoint; you cannot delete all breakpoints.
3. Edit Color: To change the colors between breakpoints, move the pointer over a
color area between breakpoints. When the cursor changes to a pen, click to open
a color selection dialog.
There are two selections for Adult Reference:

● BMD
● BMC
There are six selections for Pediatric Reference:
● Area vs Height
● BMC
● BMC vs Area
● BMC vs Height
● BMD
● BMD vs Height
Click the Restore Defaults button to restore all default breakpoints and colors (Centile
and Z-Score).
Enhanced Total Body Analysis
Enhanced analysis is now available for Prodigy Total Body scans. The previous type
of analysis is called Basic. Enhanced contains all of the improvements in iDXA Total
Body analysis:
1. Point typing is improved, especially for younger and smaller subjects
2. The soft tissue composition model is improved
If the site is installing enCORE over a previous version, the default analysis type will
be Basic. (New installations will default to Enhanced analysis.) Sites installing over a
previous version, with previous scans on the system, will be prompted when opening a
previous scan whether to upgrade the scan if Enhanced analysis is selected.
Answering Yes causes the scan to be reanalyzed in the current mode, and answering
No leaves the analysis as it is.
The default scan type (Basic or Enhanced) is set in Tools > User Options > Analyze tab
> Total Body Analysis Options button (see Analyze Tab (242)).
Total Body scans acquired with Small mode only support Enhanced analysis.
Body Composition Measurement and Analysis

Body Composition software measures the regional and whole body lean and fat tissue
mass, and calculates other derivative values which can be displayed in user-defined
statistical formats and trends, and compared to reference populations at the sole
discretion of the healthcare professional. Some of the diseases/conditions for which
body composition values are useful include chronic renal failure, anorexia nervosa,
obesity, AIDS/HIV, and cystic fibrosis.
Body Composition Measurement

Make sure all attenuating materials (belts, metal buttons, etc.) are removed from the
measurement region. For Total Body scans, all materials that may cause significant
attenuation must be removed. CoreScan results require the abdominal region must
not have tight waistbands and be completely free of all metal.
1. Help the patient onto the scanner table and position the patient as follows:
A) The patient’s body is in the center of the scanner table. Use the centerline on
the table as a reference to align the patient.
If a patient is wider than the scan area, the patient can
be positioned for a half body scan (also known as a
MirrorImage scan). In addition to all of the right side of
the body, the entire head and spine should be included
in the scan window.
B) The patient’s hands are turned on sides with thumbs up, palms facing legs and
arms are alongside the patient’s body. If possible, hands should not touch legs.
CoreScan results require that hands do not touch legs and there is a small air gap
(~1 cm) between the arms and torso. Verify that the patient’s arms are within
the scan area lines on the table pad.
C) Velcro strap.
3. Remove the patient’s shoes.
4. Make sure the patient’s head is approximately 3 cm below the horizontal line
on the table pad.
5. Use the Velcro straps to secure the patient’s knees and feet to prevent movement
during the measurement.
You are not required to adjust the scan arm position for
Total Body measurements.
A correct Total Body image shows the patient's entire body. Make sure the head
(1), feet (2), and arms (3) are shown in the image.
Correct total body image
Body Composition Analysis

Composition results are shown on the screen when you select the Composition
tab in the Analyze window. Results include:
● Fat mass as a percentage of total tissue mass (tissue %fat) and as a percentage
of total tissue mass and bone mass (region %fat)
● Total mass in kilograms or pounds
● Grams or pounds of soft tissue, fat tissue, and lean tissue
● BMC in grams or pounds
● Centile or Z-score
● BMI
● If CoreScan option is purchased, Estimated VAT volume in cm3 or in3 and mass
in grams or pounds
Options for Centile or Z-score and Metric or English (US) results are found under
Tools > User Options > Results Display > Composition Options.
2. Use the cut positions to define the tissue regions. Adjust the cuts as necessary to
include all of the tissue in the appropriate regions. Be very careful to separate the
arm regions from the tissue in the hips and thighs.
Body composition analysis cuts
3. To print a report, select the Composition report option in the Reports dialog box.
Left Total/Right Total Regions
The option to generate total left and total right regions is located in Tools > User
Options > Analysis tab. Check the option box to enable Left/Right Total Body results.
Half Body/MirrorImage Scan to Estimate Composition
For very wide patients that do not fit within the scan boundaries, it is recommended
that you perform analysis of half of the body, then use the Estimate tool to estimate
one side of the body from the other.
In this example, only the entire right half of the body fits into the scan area.
Half body (MirrorImage) scan image
Click ROIs, and then click Estimate to estimate one side of the body from the other.
If the Total Body is derived from an estimate from half of the body, (e) appears next to
the Region column in Densitometry and Composition results tables, and next to the
Measured Date column in Trend tables.
Densitometry table with estimated results
Composition Measurement of Android and Gynoid Fat

Android and Gynoid Composition ROIs are available in analysis.
Basic ROI descriptions:
● Android ROI: Lower boundary at Pelvis cut. Upper boundary above Pelvis cut by
20% of the distance between Pelvis and Neck cuts. Lateral boundaries are the
Arm cuts.
● Gynoid ROI: Upper boundary below the Pelvis cut line by 1.5 times the height of the
Android ROI. Gynoid ROI height equal to 2 times the height of the Android ROI.
Lateral boundaries are the outer Leg cuts.
Android and gynoid composition ROIs
The Android/Gynoid (A/G) ratio is the ratio between the %Fat of the Android (central)
and %Fat of the Gynoid (hip and thigh) regions. The Enhanced Composition report
page displays the Android/Gynoid ratio.
Composition BMI (Body Mass Index)
BMI reference graph is from the World Health Organization's classification. BMI is
shown on the Composition results tab if the BMI user option is enabled. The graph is
intended for adult men and nonpregnant women that are 20 years of age or older.
The BMI is a simple but objective anthropometric indicator of the nutritional status
of the adult population.
The configurable reference graph divisions are:
● Underweight (<18.5 BMI)
● Normal (18.5-24.9 BMI)
● Overweight (25.0-29.9 BMI)
● Obese (30.0 and above)
BMI = Weight in kilograms / (Height in meters)2
Body Composition BMI Graph is available in Composer Reports as an option.
BMI does not distinguish between fat and lean. Therefore, BMI
is not a good indicator of ideal body weight for athletes and
body builders with above average lean muscle mass. In other
words, an athlete with a large muscle mass may have a BMI
in the overweight range, but not be overweight for his/her
body size.
CoreScan (Estimated VAT)

The CoreScan software option estimates the VAT (Visceral Adipose Tissue) content
within the android region. The content that is estimated is the VAT mass and VAT
volume. The values can be displayed in user-defined statistical formats and trends.
Results have been validated in a male and female sample population between the
ages of 18 and 90 years with a BMI between 18.5 and 40 excluding pregnant women.
The values are displayed on the CoreScan tab on the Analysis screen.
CoreScan results are found on the Total Body Composition Ancillary Report, and
Composer field codes are available. See Creating a Report (193) and DXA Results
Reports (191) for more information on generating reports.
References:
● Kaul S, Rothney MP, Peters DM, Wacker WK, Davis CE, Shapiro MD and Ergun DL:
Dual-energy x-ray absorptiometry for quantification of visceral fat. Obesity (Silver
Spring) 20:1313-8, 2012
Composition Trending Options
Composition trending tables display the Composition Trend of the region selected
and the Fat Distribution.
1. The options to change trending graphs are found on the Composition Trend tab
on the Analysis screen:
Composition trending options
● From the Region drop down menu (1), choose the region to trend.
● From the Display menu (2), choose a display option. Options include Absolute
Value, Change vs., Mass (Total, Fat, Lean), Mass (Total, Fat, Lean, TBW), and
Reference.
● If you select Change vs. for the Display option, a single Trend On menu
appears (3). Choose a value from the Trend On menu for Y1 only. This plots
%Change vs Previous or Baseline for Y1.
If you select Absolute Value for the Display option, two Trend On menus
appear (3 and 4). Choose a value from the Trend On menus for both Y1 and Y2.
Y1 is represented in black and appears on the left axis. Y2 is represented in

magenta and appears on the right axis.
● Additional Trend On options A/G Ratio and Total Body (%Fat) are available.
2. If needed, change Line Pattern and Change vs. [Baseline, Previous (absolute
plot), or Previous (relative plot)] under Tools > User Options > Trending > Trend
Graph Options.
3. If needed, change Display, Y1, and Y2 options under Tools > User Options >
Trending.
Example of a 3–line composition trending graph
Composition Report Options

Composition Ancillary Report: In addition to the main Composition report, enCORE
also features a Composition Ancillary Report. The Ancillary report page includes:
● Fat mass ratios of Trunk/Total, Legs/Total, and (Arms+Legs)/Trunk
● Resting Metabolic Rate (RMR)
● Relative Skeletal Muscle Index (RSMI)
● Total Body Water (TBW)
● Intracellular Water (ICW)
● Extracellular Water (ECW)
Enhanced Composition Report: enCORE also features an Enhanced Composition
Report option. This report provides the Composition Reference Graph, a Composition
Trend Graph, a Fat Distribution Table, and the WHO BMI reference chart.
Estimated Total Body Fat and Android/Gynoid Fat
Using the scan tissue data from standard spine and femur scans, it is possible to
make an estimate of the total body %Fat and Android/Gynoid %Fat. The required
scan types are:
● An exam with AP Spine and Femur
● An exam with AP Spine and Dual Femur (averaged value)
On the Analysis screen for Spine/Femur exams, the Composition tab displays a
reference graph, BMI graph, and table that includes Tissue (%Fat), Tissue (%Lean),
and Centile.
Composition tab, Estimated Total Body
In the Report Center for Spine/Femur exams, the Estimated Total Body Exam report
includes a reference graph, trend graph (when applicable), BMI graph, and table that
includes Tissue (%Fat), Tissue (%Lean), and Centile.
Estimated Total Body Composition Limitations
68% of estimated total body %Fat values will be within approximately 3% of the
measured value for males and females. The estimated Total Body %Fat estimates are
only valid for Caucasian and Asian patients. The estimated Android and Gynoid %Fat
estimates are only valid for Caucasian patients. Patient’s age, weight, height, BMI,
and spine and femur measurement values fall must fall within limited ranges (see
tables below for details).
Caucasian Range Limits for Valid Total Body %Fat Estimation Variables
Female Male
Age (yrs) Min 20 20
Max 100 100
Height (cm) Min 130 150
Max 185 200
Weight (kg) Min 40 55
Max 135 125
Female Male
BMI (kg/ m²) Min 15 18
Max 45 42
Spine %Fat Min 2 2
Max 55 55
Spine Thickness (cm) Min 11 13
Max 27 29
Femur %Fat Min 10 10
Max 50 40
Femur Thickness (cm) Min 10 12
Max 25 22
Predicted Total Body %Fat Min 10 10
Max 60 45
Caucasian Range Limits for Valid Android & Gynoid %Fat Estimation Variables
Female Male
Age (yrs) Min 20 20
Max 100 100
Max 185 200
Max 135 125
Max 45 42
Spine %Fat Min 2 2
Max 55 53
Max 27 28
Femur %Fat Min 10 10
Max 50 40
Max 23 22
Max 60 45
Gynoid %Fat Min 22 20
Max 62 49
A/G Ratio Min 0.3 0.75
Max 1.25 1.6
Android %Fat Min 2 18

Max 61 53
In addition to the above fixed ranges for Total Body, Android, and Gynoid %Fat, the
spine thickness values should fall within limits which vary with BMI which are given in
the equations below (BMI is calculated from the entered height and weight):
● Caucasian Female spine tissue thickness (cm) = -9.014 + 5.214√(BMI) ± 3.8 cm
● Caucasian Male spine tissue thickness (cm) = -6.726 + 5.199√(BMI) ± 3.0 cm
Android and Gynoid %Fat has an additional limitation:
● Spine Thickness / Femur Thickness = 1.46
Asian Range Limits for Valid Total Body %Fat Estimation Variables
Female Male
Age (yrs) Min 20 20
Max 90 90
Max 180 180
Max 90 92
Max 35 31
Spine %Fat Min 5.85 4.79
Max 55 46
Max 21 22
Femur %Fat Min 9 5.85
Max 45 34
Max 17 17
Max 50 43
In addition to the above fixed ranges, the spine and femur thickness values should
fall within limits which vary with BMI which are given in the equations below (BMI is
calculated from the height and weight entered):
● Asian Female spine thickness (cm): 7.861 + 0.06798*BMI1.5 ± 5.54
● Asian Female femur thickness (cm): 0.07868 + 2.669*√(BMI) ± 3.39
● Asian Male spine thickness (cm): -8.958 + 5.313√(BMI) ± 6.63
● Asian Male femur thickness (cm): -2.633 + 3.277√(BMI) ± 4.10
Composition Color Mapping
iDXA Total Body images can be color mapped.
1. Click the Color Mapping button to the left of images in the Analysis screen
to display color mapping.
Color mapped image
2. Click the Color Mapping Thresholds button to make threshold adjustments.

Color Mapping Thresholds dialog
Default tissue mapping colors are red, yellow, and green, where:
● Green represents an area of low level %Fat
● Yellow represents an area of medium level %Fat
● Red represents an area of high level %Fat
These colors can be customized under Tools > User Options > Image > Image
Colors.
Composition Color Coding
Color Coding is available on total body scans with iDXA, or Prodigy enhanced or basic
analysis.
1. Click the Color Coding button to the left of images in the Analysis screen
to display color coding.
Color Coding image
These colors can be customized under Tools > User Options > Image > Image
Colors (see Image Tab (246)).
Image Colors dialog
2. Click the Color Coding Spectrum to adjust contrast settings.

Default colors are white, grey, orange, and yellow, where:
● White is bone
● Grey is bone edge
● Orange is lean tissue
● Yellow is fat tissue
The Image Colors dialog also allows you to change the default contrast settings
for the Color Coding image, and change which color method appears initially
when opening a new total body exam.
For Color Coding images, adjusting the contrast modifies the colors on the image.
(This is different from Color Mapping images, where the colors are constant
regardless of brightness/contrast settings.)
The color options selected on screen also appear on the standard DXA reports
for Total Body.
Composition Options
The Composition Options dialog lets you change the body composition graph
breakpoints and colors. Access these options in Tools > User Options > Results
Display > Composition Options.
Composition Options dialog
Measurement System can be set to Metric or English. This setting affects the
Composition results (not Densitometry).
Results can be set to Z-Score or Centile. There are two sets of editable graph
breakpoints and colors, one for each result type. Select Z-Score or Centile to see a
color control dialog where you can adjust the settings for that result.
The Breakpoints color control has three options:
1. Add/Shift: Add a breakpoint by moving the mouse to an open area between
existing breakpoints. When the pointer changes to a plus sign, click to add a
new breakpoint.
In Centile mode, the range of breakpoints that can be added is 1 to 99, in whole
number increments. In Z-Score mode, the range is -4.0 to +4.0, in 0.1 increments.
Shift (move) an existing breakpoint by moving the pointer to an existing
breakpoint. When the pointer changes to an arrow, drag the selected breakpoint
to the desired level.
When moving breakpoints, you cannot move it past a neighboring breakpoint.
2. Delete: Delete a breakpoint by moving the pointer to an existing breakpoint.
When the pointer changes to an X, click to delete the selected breakpoint.
You must have at least one breakpoint; you cannot delete all breakpoints.
3. Edit Color: To change the colors between breakpoints, move the pointer over a
color area between breakpoints. When the cursor changes to a pen, click to open
a color selection dialog.
Click the Restore Defaults button to restore all default breakpoints and colors (Centile
and Z-Score).
Metabolic Information
The following are Composer field codes and are on the Total Body Composition
Ancillary DXA Report:
● Resting Metabolic Rate (RMR)
● Relative Skeletal Muscle Index (RSMI)
● Total Body Water (TBW)
● Intracellular Water (ICW)
● Extracellular Water (ECW)
The above metabolic information is displayed on the Metabolic tab on the Analysis
screen for total body exams. You can configure the display of this information in Tools
> User Options > Results Display > Metabolic Options.
RMR and RSMI are available for patients age 18 and over.
Resting Metabolic Rate (RMR)

RMR, which is synonymous with Resting Energy Expenditure (REE), is an estimate
of how many calories are burned at a resting state and represents the minimum
amount of energy needed to maintain body temperature, heartbeat, and respiratory
rate. There are three ways to calculate RMR: Harris-Benedict[1], Mifflin-St. Jeor[2],
or enter manually.
The Harris-Benedict equation is:
RMR(male) = 66.473 – (6.775 x age[yrs]) + (13.7516 x
weight[kg]) + (5.0033 x height[cm])
RMR(female) = 655.0955 – (4.6756 x age[yrs]) + (9.5634 x
weight[kg]) + (1.8496 x height[cm])
where weight is the entered patient weight.
The Mifflin-St. Jeor formula is:
413 + 19.7 x FFM (kg)
where FFM (Fat Free Mass) = Lean mass (kg) + Bone mass (kg)
[1] Harris JA, Benedict FG. A biometric study of basal metabolism in man. Washington,
DC: Carnegie Institute of Washington, 1919. (Carnegie Institute of Washington
Publication 279).
[2] Mifflin, M.D., S.T. St Jeor, L.A. Hill, B.J. Scott, S.A. Daugherty, and Y.O. Koh, A new
predictive equation for resting energy expenditure in healthy individuals. Am J Clin
Nutr, 1990. 51(2): p. 241-7.
Relative Skeletal Muscle Index (RSMI)
RSMI represents the relative amount of muscle in the arms and legs and is calculated
using the Baumgartner equation [1]:
RSMI = (lean mass of arms[kg] + lean mass of legs[kg]) / (height[m2])
[1] Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR,
Garry PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in New
Mexico. Am J Epidermiol 147(8):755-763.
Total Body Water (TBW)

Total Body Water (TBW) makes up 50% to 70% of total body weight, with the
variability due primarily to differences in body fat. Lean muscle tissue is made up
of a high percentage of water, whereas adipose and visceral tissue (fat) contain a
very small amount. The balance of fluids is vital for optimal metabolism and human
performance. Fluid balance and proper hydration help the body transport nutrients
while removing by-products of metabolism and toxins.
Intracellular Water (ICW)
Intracellular water (ICW) is the water within your body that is found within the cells in
your body. Intracellular water makes up the largest portion, approximately two-thirds,
of the water within the body.
Extracellular Water (ECW)
Extracellular water (ECW) is the water within your body that is outside of the cells.
Sarcopenia (Muscle Loss with Aging)

Sarcopenia is a disease associated with the aging process. Loss of muscle mass and
strength affects balance, gait, and the ability to perform daily living tasks. Sarcopenia
most commonly is seen in inactive people but can also affect individuals who remain
physically active throughout their lives.
Enabling and Configuring Sarcopenia

If you purchased the Sarcopenia software feature, enable it by selecting Tools > User
Options > Analyze tab > Total Body Analysis Options. Select the Change button in
the Sarcopenia Definition group to display the Sarcopenia Definition dialog.
Sarcopenia Definition dialog
Configure the sarcopenia definition according to site needs by selecting a default

sarcopenia definition1 and selecting OK.
1Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in
Asia: consensus report of the Asian Working Group forSarcopenia.
JAMDA. 2014;15:95–101
Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus

on definition and diagnosis: report of the European Working Group on Sarcopenia in
Older People.
Age and Ageing 39(4):412–423
Studenski SA, Peters KW, Alley DE et al (2014) The FNIH sarcopenia project: rationale,
study description, conference recommendations, and final estimates.
J Gerontol A Biol Sci Med Sci 69(5):547–558
Fielding RA, Vellas B, EvansWJ et al (2011) Sarcopenia: an undiagnosed condition in

older adults. Current consensus definition: prevalence, etiology, and consequences.
International working group on sarcopenia.
J Am Med Dir Assoc 12(4):249–256
Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia

among the elderly in New Mexico.
Am J Epidemiol 147(8):755–763
Advanced Mode
Check Advanced to display the following options:
● View button: Display the selected definition classification(s).

● New button: Create a new (user) definition. The user definition will default to the
formulas in the current selection.
Sarcopenia Definition Advanced Options
Abbreviation and Name: Enter an abbreviated and long name for the new sarcopenia
definition.
Minimal Age: Set the starting patient sarcopenia age.
New button: Create and insert a new classification definition.
Edit button: Edit the selected classification definition.
Up and Down buttons: Move the selected classification up or down.
Classifications must be ordered from least to highest severity.
Delete button: Remove the selected classification.
Test button: Display the Sarcopenia Test dialog to allow data input for testing the
classification formula.
Classification Edit dialog
Classification field: Enter a classification name.
Logic drop-down menus: Provide the classification measurement device “and/or”

logic. Select Or() and And() to provide parentheses to indicate precedence.
Measurement: Select measurement devices used in determining sarcopenia

classifications.
Operator selections: Provide a math operation for comparison to value.
Value fields: Enter a comparison measurement value.
After completing the sarcopenia definition, use the Sarcopenia Test dialog to test
data inputs. Enter values and select Calculate to ensure your sarcopenia definitions
perform as expected.
Sarcopenia Test dialog
Sarcopenia Calculator
The Sarcopenia Calculator is available for total body analysis when the patient meets
the minimum sarcopenia definition age.
Sarcopenia Calculator
1. Sarcopenia definition group and classifications used to calculate sarcopenia.

2. Measurement device entry and Calculate button.
ALM, ALM/BMI, and ALM/Ht2 are automatically calculated by the enCORE analysis
software and are not editable. The calculator button can be used to calculate
Gait Speed in m/s.
3. Sarcopenia calculated classification result.

4. Display type:
● Current Results (shown above): Allow data input and Sarcopenia calculation
for the open exam.
● Trend: Absolute Value: Displays trend graph and table for Sarcopenia results.
● Trend: Change vs: Displays trend graph and table for Sarcopenia Change
vs. results.
Sarcopenia Reports
Report (DXA) Sarcopenia is available on the Reports Center dialog to show either
current exam results (non-trending) or trend results based on the Report Center Trend
checkbox.
Refer to Create a Report (193)and DXA Reports (191)for more information on

generating reports.
Lateral Spine Measurement and Analysis

Lateral Spine measurement and analysis provides an estimate of bone mineral density
for the lumbar spine. These values can then be compared to an adult reference
Lateral Spine Measurement

Lateral Scans provide BMD values only.
1. Put the lateral positioner on the table.
Positioner A should unfold and set over the back rail of the table.
Positioner B should be placed on top of the spine strap (1) and against the back
rail of the table (2).
The lateral positioner and the instructions below are intended to position the
lumbar spine straight and parallel to the scanner table.
2. Set a pillow on the table for the patient's head.
3. Position the patient's knees toward the chest until the lower back and both
shoulders are flat against the lateral positioner.
4. Make sure the patient's spine is parallel to the scanner table.
5. Complete patient positioning as follows:

Positioner A:
● Place a pillow under the patient's head.
● Set a foam wedge below the bottom knee and between the knees for comfort.
● Make sure the patient's back and hips are flat against the positioner.
● Patient's arms should be 90 degrees from the chest.
Positioner B:
● Pull the compressor strap over the patient's torso and secure it to the back of
the positioner. Make sure the strap does not hang over the back edge of the
scanner.
● Set a foam wedge between the patient's thighs and the bottom of the
positioner. Set a second wedge between the patient's knees, and set a third
wedge below the bottom knee. Make sure the patient's back is flat against the
positioner and adjust the strap so the patient does not roll forward during
the measurement.
● Adjust the foam wedge between the back of the patient's thighs and the
positioner to hold the knees in place during the measurement.

7. Adjust scan length or width as needed.
8. For patients that are unable to rest on their left side for LVA scanning, select the
Reverse box to allow the patient to rest on their right side and reverse the scan
arm direction.
9. Use the graphic shown on the New Measurement screen to adjust the position of
the laser light. Position the Laser Light at the top of the patient's iliac crest.
Lateral Spine measurement
Adjust as follows:
● End in L1
● All posterior elements visible
● 2.5+ cm tissue
● Start in sacrum so that all of L5 is visible
● The image starts in the sacrum so that all of L5 is visible (1)
● At least 2.5 cm of soft tissue is shown on the anterior side of the vertebrae (2)
● The image ends in L1 (3)
● All of the posterior elements appear in the image (4)
● The edge of the positioner may appear in the image; this is not a problem (5)
Correct Lateral Spine image
the measurement.
Lateral Spine Analysis

Lateral scans provide BMD values only.
2. Select the imaging tool to adjust the image.
3. If necessary, adjust the Body ROIs using the arrow keys or the mouse.
Do not make any changes to the locations of the ROIs unless the program made
obvious errors.
● The Body ROI should be positioned with the top of the ROI just below the upper
vertebral endplate and the bottom of the ROI just above the lower vertebral
endplate.
● Each ROI should contain only bone.
● Do not analyze B4 if the pelvis covers part of the vertebral body.
● Do not analyze B2 if ribs cover part of the vertebral body.
Lateral spine image
4. To invert the contrast of the images, go to Tools > User Options > Images tab,
and check the option to Invert Images.
5. Select Points from the Analyze toolbar to adjust point typing.
Lateral bone points Lateral neutral points Lateral tissue points
6. Select Results to view the new analysis results based on your changes.
changes.
LVA Morphometry Measurement and Analysis

If you purchased the LVA Morphometry option for your bone densitometer, LVA
Morphometry features appear in the enCORE software.
LVA Morphometry measurement and analysis provides an x-ray image of the spine for
qualitative visual assessment in order to identify vertebral deformations and estimate
vertebral heights (morphometry).
LVA Morphometry Measurement

Positioner B should be placed on top of the spine strap (1) and against the back
rail of the table (2).
5. Complete patient positioning:

Positioner A:
Positioner B:
● Pull the compressor strap over the patient's torso and secure it to the back of
the positioner. Make sure the strap does not hang over the back edge of the
scanner.
● Set a foam wedge between the patient's thighs and the bottom of the
positioner. Set a second wedge between the patient's knees, and set a third
wedge below the bottom knee. Make sure the patient's back is flat against the
positioner and adjust the strap so the patient does not roll forward during
the measurement.
● Adjust the foam wedge between the back of the patient's thighs and the
positioner to hold the knees in place during the measurement.

LVA measurements produce BMD results only when
SmartScan is turned off. When SmartScan is on, the scan
time is reduced.
7. Adjust scan length or width as needed. LVA Morphometry scan length can be
increased to 55.4 cm.
arm direction.
LVA Morphometry measurement
Adjust as follows:
● End near T4
● 2.5+ cm tissue
● The image starts in the Sacrum so that all of L5 is visible
● At least 2.5 cm of soft tissue is shown on the anterior side of the vertebrae
● The image ends near T4
● All of the posterior elements appear in the image
The edge of the positioner may appear in the image. This is not a problem.
the measurement.
LVA Morphometry Analysis

2. Select the Imaging tool to adjust the image. The ClearView slider enhances the
bone edges of the vertebrae.
3. To invert the contrast of images, navigate to Tools > User Options > Images and
check the Invert Image option.
LVA image Inverted LVA image
4. Select the desired analysis type under Tools > User Options > Analyze tab and
select the Morphometry options.
Morphometry Options dialog
5. Enable the Morphometry Wizard, then follow the steps for the analysis type
selected.
● Create ROIs on Request (151)
● Automatically create Reference ROIs when needed (152)
● Automatically create ROIs for T8-L4 when opening exam (152)
6. The software automatically assigns the Morphometry deformity label for all
analysis types.
7. To change a Morphometry deformity label, click the Deformity icon and then
click on the vertebra of interest.
Only use this tool to override automated morphometry
analysis.
8. At the warning, click OK.
9. From the list of deformities, select the desired deformity indication label.
Icon Deformity label
Mild Wedge
Moderate Wedge
Severe Wedge
Mild Biconcavity
Moderate Biconcavity
Severe Biconcavity
Mild Compression
Moderate Compression
Severe Compression
When you assign a deformation to a vertebra, the symbol for the deformation
appears next to the ROI label in the results table in the Analysis window.
changes.
Create ROIs on Request (Recommended)
1. Click on a vertebra that appears deformed. Click as close to the center of the
vertebra as possible.
The Morphometry Wizard window opens.
2. Verify the ROI label and positioning and make appropriate changes if necessary.
Make sure each vertex of the ROI is centered in the vertebral endplate. Redo the
auto-endplate finding by double-clicking in the exact center of the vertebra.
3. Click Next.
4. Click L4 in the Morphometry Wizard window and click Next.
5. Verify the heights of L2, L3, and L4 and make changes as needed.
These vertebrae are used as a reference data stature adjustment. If any of these
vertebrae are deformed, it is not used in the stature adjustment.
6. Click Finish.
7. To analyze additional vertebrae, repeat the steps above and click Finish.
Automatically Create Reference ROIs when Needed

1. Click a vertebra that appears deformed. Click as close to the center of the
vertebra as possible.
auto-endplate finding by double-clicking in the exact center of the vertebra.
3. Click Finish.
L2, L3, and L4 ROIs are automatically created.
4. Verify the heights of L2, L3, and L4. If changes are necessary, click on the vertebra
to open the Morphometry Wizard and make appropriate changes.
5. To analyze additional vertebrae, repeat the steps above and click Finish.
Automatically Create ROIs for T8-L4 when Opening Exam
1. T8-L4 ROIs are automatically created when you open the scan for analysis.
2. Verify ROI label and positioning. If changes are necessary, click on the vertebra to
open the Morphometry Wizard and make appropriate changes.
3. To analyze additional vertebrae, click a vertebra, as close to the center as possible.
auto-endplate finding by double-clicking the exact center of the vertebra.
5. Click Finish.
LVA Morphometry Analysis Tools
Morphometry Select Morphometry to complete
a morphometry analysis of an LVA
measurement.
Density Select Density to perform bone density
analysis of an LVA measurement.
This option is not available if you used
SmartScan during measurement.
Morphometry Wizard Select this tool to start the Morphometry
Wizard, which labels, measures, and
assigns deformities to the vertebrae.
See the table below for details.
Change Deformity Select Change Deformity Indication,
Indication and then click the target ROI to set or
change the deformity assessment for
a vertebra.
Use this tool only to override automated
morphometry analysis.

Show/Hide ROIs Click to show or hide ROIs on screen
and reports.
Morphometry reports do not show
ROIs.
Delete ROI Click Delete, and then click the target
ROI.
With the Morphometry Wizard enabled, the following tools become available after
clicking a target ROI:
Move/Size ROI Click the Move / Size ROI tool, and then
click and drag ROI or edges as needed.
Rotate ROI Click the Rotate ROI tool, and then click
and drag near the corner of (but inside)
the ROI to rotate it.
Adjust Vertices Click the Adjust Vertices tool, and then
click and drag vertices as needed.
Position Reference ROIs This tool is available on LVA scans after
reference vertebrae are identified, and
is used to reposition the reference ROIs.
Label ROI From the drop-down menu, select the
correct vertebra to label the ROI.
LVA Morphometry Configuration

The enCORE software provides morphometry results for the vertebrae of interest
according to the parameters set in Tools > User Options > Results Display >
Morphometry Reference Options.
● Z-Scores mode uses Average Height Z-Score to determine compression, A/P ratio
Z-Score to determine wedge, and M/P ratio Z-Score to determine biconcavity
deformities and includes stature adjustment.
Z-Scores mode
● Percent Reduction (%) mode uses P/A ratio to determine compression, A/P ratio to
determine wedge, and M/P ratio to determine biconcavity deformities.
Percent Reduction mode
To use average height to determine compression, check Stature Adjustment.

(This requires the additional step of confirming that the heights are set properly
for L2-L4.)
● Cutoffs determine which deformities will be labeled as Mild, Moderate, or Severe.
Adjust as necessary.
Trending Morphometry Options
Options to trend Morphometry results on-screen are set in Tools > User Options >
Trending.
You can change Trend On options under Tools > User Options > Trending, using the
Morphometry drop-down menu, or on the Morphometry Trend tab on the Analysis
screen. You can choose to trend on A/P Ratio, Anterior Height, Average Height, M/P
Ratio, Middle Height, P/A Ratio, or Posterior Height.
Trend Graph Options are set in Tools > User Options > Trending > Trend Graph
Options.
Trend Table Options are set in Tools > User Options > Trending > Trend Table Options.
Options to trend Morphometry on DXA reports are set in Tools > User Options >
Reports > Morphometry Report Options. You can select multiple trend results for a
single report.
Composer Trending options are configured in Composer.
LVA Spine Geometry Measurement and Analysis

If you purchased the Spine Geometry option for your bone densitometer, LVA Spine
Geometry features appear in the enCORE software. LVA Spine Geometry measurement
and analysis provides an x-ray image in order to identify and measure Cobb angles.
LVA Spine Geometry Measurement

5. Complete patient positioning:

LVA measurements produce BMD results only when
SmartScan is turned off. When SmartScan is on, the scan
time is reduced.
7. Select the Include Cervical Spine box.
8. Adjust scan length or width as needed. LVA Spine Geometry scan length should be
increased to 69.5 cm.
arm direction.
LVA Spine Geometry measurement
Adjust as follows:
● End near C1
● 2.5+ cm tissue
● The image starts in the sacrum so that all of L5 is visible
● At least 2.5 cm of soft tissue is shown on the anterior side of the vertebrae
● The image ends near C1
● All of the posterior elements appear in the image
The edge of the positioner may appear in the image. This is not a problem.
the measurement.
LVA Spine Geometry Analysis

2. Use the LVA Spine Geometry Analysis tools to adjust ROIs, if needed.
In most cases, the software automatically places the ROIs. The vertebrae used
for analysis are defined as the last vertebral bodies at extreme ends of the spinal
curvature, where the end plates tilt to the side of curvature concavity.
3. To add additional ROIs, click the Add ROI button or press the Insert key.
4. From the Add ROI menu, select a vertebra and move the ROI line through the
superior end plate of the chosen vertebra using the Spine Geometry analysis
tools, if necessary.
5. Click the Add ROI button or press the Insert key again.
6. From the Add ROI menu, select another vertebra.
Another ROI line is placed on the LVA scan.
7. Move the ROI through the inferior end plate of the chosen vertebra using the Spine
Geometry analysis tools, if necessary.
The Cobb Angle (degrees) are shown to the right of the scan image under the
Geometry tab in the Geometry table.
LVA Spine Geometry Analysis Tools

Move/Size ROI Click Move/Size ROI, and then click and
drag ROI or edges as needed.
Rotate ROI Click Rotate ROI, and then click and
drag near the end of the ROI.
Delete ROI Click Delete, and then click the target
ROI.
Add ROI Click Add ROI, and then select the

desired ROI from the menu.
Label ROI Select the ROI to relabel, then click

Label ROI and choose the desired label
from the menu.

Angle After at least two ROIs have been
added, the Angle tool is activated. Click
Angle to change angle configurations.
Show/Hide ROIs Click to show or hide ROIs.
LVA Spine Geometry Reporting

Three reports are available for LVA Spine Geometry reporting:
LVA Spine Geometry Displays the LVA scan image and any Cobb Angle analysis.
Dual VA Spine Displays the LVA and APVA scan images only. This report is
Geometry Standard only available if the exam contains both LVA and APVA scans.
Dual VA Spine Displays the Cobb Angle analysis without images. This
Geometry Ancillary report is only available if the exam contains both LVA and
APVA scans.
APVA Morphometry Measurement and Analysis

APVA Morphometry measurement and analysis provides an x-ray image of the spine
for qualitative visual assessment in order to identify vertebral deformations.
APVA Morphometry Measurement

of the scan table.
2. Use the centerline on the table as a reference to align the patient.
The patient's arms should be on the scanner table, beside the patient's body.

APVA Morphometry scan length can be increased to 55.4 cm
of the laser light. Position the laser light approximately 5 cm below the patient's
navel.
Start in L5, and end the scan in T4.

the measurement.
APVA Morphometry Analysis

2. If necessary, select Imaging from the Analysis toolbar to adjust the image.
Specify Deformity Used to set the deformity assessment for a
vertebra.
Delete ROI Click this tool, and then click the target ROI.
3. Click the vertebra you want to analyze, and select a label for the vertebra.
4. Select a deformation for the vertebra.

When you assign a deformation to a vertebra, the symbol for the deformation
appears next to the ROI label in the results table in the Analysis window.
5. To change a Morphometry deformity label, click Specify Deformity and then click
the vertebra of interest.
changes.
APVA Spine Geometry Measurement and Analysis

If you purchased the Spine Geometry option for your bone densitometer, APVA
Spine Geometry features appear in the enCORE software. APVA Spine Geometry
measurement and analysis provides an x-ray image in order to identify and measure
Cobb angles.
APVA Spine Geometry Measurement

of the scan table.
2. Use the centerline on the table as a reference to align the patient.
The patient's arms should be on the scanner table, beside the patient's body.

Select the Include Cervical Spine box.
APVA Spine Geometry scan length should be increased to 69.5 cm.
of the laser light. Position the laser light approximately 5 cm below the patient's
navel.
Start in L5, and end the scan at the mandible.
the measurement.
APVA Spine Geometry Analysis

The software will automatically place the ROIs in most cases. The vertebrae used
for analysis are defined as the last vertebral bodies at extreme ends of the spinal
curvature, where the end plates tilt to the side of curvature concavity. Use the
APVA Spine Geometry Analysis tools to adjust ROIs. In patients with multiple spinal
curves, each component can be measured.
2. To add additional ROIs, click the Add ROI button or press the Insert key.
The Add ROI menu appears.
3. Select the superior end vertebra from the menu and move the ROI line through
and parallel to the superior end plate on the superior end vertebra using the Spine
Geometry analysis tools, if necessary.
4. Click the Add ROI toolbar button or press the Insert key again.
The Add ROI menu appears.
5. Select the inferior end vertebra and move the ROI line through and parallel to the
inferior end plate on the inferior end vertebra using the Spine Geometry analysis
tools, if necessary.
The Cobb Angle (degrees) are shown to the right of the scan image under the
Geometry tab in the Geometry table.
APVA Spine Geometry Tools

Move/Size ROI Click Move/Size ROI, and then click and drag
ROI or edges as needed.
Rotate ROI Click Rotate ROI, and then click and drag near
the end of the ROI.
Delete ROI Click Delete, and then click the target ROI.

Add ROI Click Add ROI, and then select the desired ROI
from the menu.
Label ROI Select the ROI to relabel, then click Label ROI.
Choose the desired label from the menu.
Angle After at least two ROIs have been added, the
Angle tool is activated. Click Angle to change
angle configurations.
Show/Hide ROIs Click to show or hide ROIs.
APVA Spine Geometry Reporting

Three reports are available for APVA Spine Geometry Reporting:
APVA Spine Geometry Displays the APVA scan image and any Cobb Angle
analysis.
Dual VA Spine Displays the LVA and APVA scan images only. This report
Geometry Standard is only available if the exam contains both LVA and APVA
scans.
Dual VA Spine Displays the Cobb Angle analysis without images. This
Geometry Ancillary report is only available if the exam contains both LVA and
APVA scans.
Dual VA Measurement and Analysis

Dual VA measurement includes both APVA and LVA measurements in one exam.
Pediatric Measurement and Analysis

Pediatric measurement and analysis is a purchased option that provides BMD,
BMC, fat mass, and lean mass for patients from birth to 20 years old. Z-Scores,
age-matched percentages, or centiles are used to compare pediatric patients to their
peers. Pediatric patients have not yet reached their peak bone densities.
Reference data is available for US(Lunar), US(BMDCS), US(NHANES 1999–2004), China,
Asia, and European populations for AP Spine, Femur or Total Body measurements for
males and females 5-19 years old depending on the reference population.
When a patient’s age is less than 20 years, additional pediatric patient information
fields appear automatically. Pediatric Skeletal Age and Pubertal Stage information is
obtained by the physician through other means.
Pediatric reference data use SDs that vary with age because children mature at
different rates.
Pediatric Measurement
Measurement procedures are the same as the procedures for adult patients. Refer to
the appropriate topic, based on the type of pediatric measurement you are performing:
● For AP spine, refer to AP Spine Measurement (86).
● For femur, refer to Femur/Dual Femur Measurement (91).
● For total body, refer to Total Body Measurement (114).
Results may be affected if the patient moves during the scan. When scanning infants,
it may be helpful to swaddle the child in a blanket to avoid excessive motion during
the scan. Be sure the blanket is thin and made of cotton, because other materials may
appear in the scan image and lead to incorrect results.
Pediatric Analysis
1. If an image is not already open, select an image for analysis.
Pediatric analysis procedures are the same as the procedures for adult patients.
Based on the type of pediatric analysis you are performing, refer to the appropriate
topic as well as the information in the sections below:
● For total body, refer to Total Body Analysis (116)
● For AP spine, refer to AP Spine Analysis (89)
● For femur, refer to Femur/Dual Femur Analysis (96)
Pediatric Total Body Analysis
Pediatric Total Body provides reference data for US (Lunar), US (BMDCS), US (NHANES
1999–2004), China, Asia, and European populations.
The BMD of the head dominates the Total Body BMD in children. To omit the head
from Total Body results, select Tools > User Options > Analyze > Total Body Analysis
Options. Check the Total Body Less Head (TBLH) option and click OK
Select or Omit Head Region on DXA Reports
To select regions or omit the head ROI on DXA reports, follow these steps.
1. Select Tools > User Options > Reports tab.
2. Click the Report Regions button.
3. On the Total Body tab, select TBLH from the Available list on the left.
4. Click Add.
The selected ROI is added to the Selected list on the right.
5. Select the Composition tab and repeat the same steps to add TBLH ROI to the
Composition Report.
Pediatric Growth Indices

Pediatric Growth Indices can be found under the Pediatrics tab on the Analysis screen.
The software provides information on Bone Size and Lean Body Mass Assessment.
Skeletal Age and Pubertal Stage information is entered in the Patient Information
screen.
Bone Size Assessment:
● Height for Age (Centile)
● BMC for Bone Area (Centile)
● Bone Area for Height (Centile)
Lean Mass Assessment:
● LBM (lean body mass) for Height (Centile)
● BMC for LBM (Centile)
Pediatric Growth Indices are included on the Total Body Ancillary report page.
Pediatric AP Spine and Femur Analysis

1. Pediatric AP Spine and Femur provide reference data for US (Lunar), US (BMDCS),
and European populations.
Hand Measurement and Analysis

Hand measurement and analysis provides an estimate of the bone mineral density for
the hand. Reference data are not available for hand measurements.
Hand Measurement
1. Place the patient in a chair next to the scan table.
2. Have the patient place the hand flat on the table, 2 cm from the line on the table
pad, with the thumb and fingers together.
Use a chair without arms or wheels. Use the same chair for all hand
measurements to get optimal precision.
Seated hand scan
iDXA and Prodigy scanners have an option to scan the patient in a non-seated
position (Tools > User Options > Measure tab). Continue to use the same method
of positioning. If previous scans were done in a seated position, continue to use
the same scanning method to trend data.
Non-seated hand scan
Be sure the fingers and thumb are flat and together.

that gives the correct patient position and measurement start position. Be careful
that the scanner arm does not bump the patient's head.
the laser light. Position the laser light in the center of the wrist, adjacent to the
ulna styloid. Be sure all of the ulna styloid is visible.
5. To start the measurement, select Start from the New Measurement toolbar.
● The scan proceeds past all fingertips
● All of the ulna styloid is visible
Hand Analysis
2. Select Imaging from the Analyze toolbar to adjust the image.
3. Select ROI is from the Analyze toolbar to adjust ROIs.
4. Make sure the hand ROIs are positioned correctly as follows:
● The enclosed area includes the entire hand to the tips of the fingertips and
ends at the ulna styloid process
● The ROI includes the carpal bones, but not the ulna or radius
5. Select the Move ROI tool or the Move Vertex tool to adjust the edges of the
region of interest.
● Select Move ROI to move the ROI edges. Do not move the lines unless they
are obviously incorrect.
● Select Move Vertex to move the vertices of the ROI.
Hand bone points Hand neutral points Hand tissue points
not adjust the point typing unless the program made obvious errors.
on your changes.
changes.
Orthopedic Hip Measurement and Analysis

Orthopedic Hip measurement and analysis provides an estimate of the bone mineral
density around femur implants. Reference data is not available for Orthopedic Hip
measurements.
This option is only available if you purchased the Orthopedic Hip option.
Orthopedic Hip Measurement

1. In the Exam list on the New Measurement screen, select Left Ortho Hip or Right
Ortho Hip.
The scanner arm moves to the approximate start position.
3. Be sure the patient is centered and square on the table. Use the centerline on the
scanner table as a reference.
4. The patient's arms must be crossed over the chest, away from the side of each hip.
5. Place the foam knee positioner under the knee of the leg to be scanned, with the
tapered end toward the patient's thigh.
6. Strap the foot of the leg to be scanned to the vertical side of the foot brace.
The leg should be in a neutral position, NOT rotated as in the femur scan.
7. Position the leg so the femoral shaft and implant are parallel with the centerline
on the scan table.
8. Use the graphic on the New Measurement screen to adjust the position of the
laser light.
9. Position the laser light mid-thigh, approximately 3-4 cm below the implant tip.
10. Select Start from the New Measurement toolbar to start the measurement.
11. Monitor the image to make sure:
a. (1) The scan is initiated 3-4 cm below the implant tip
b. (2) The femoral shaft and implant are perpendicular to the scan path
c. (3) The scan continues 2-3 cm above the greater trochanter
Correct orthopedic hip image
the measurement.
Orthopedic Hip Analysis

2. Select Standard Gruen or Extended Gruen Zones.
3. Set the default Gruen method in Tools > User Options > Analyze, and select
Ortho Hip Analysis Options.
4. You can toggle between Standard Gruen and Extended Gruen zones on the
ROIs screen.
By default, the Gruen icon is selected and all ROIs are active. This allows you to
move all regions at the same time. However, you can move each zone individually,
if desired.
Standard Gruen zones Extended Gruen zones
5. Verify that the ROIs and implant length are correctly identified.
The tools shown below are available on the ROIs screen: Click the ROIs tool
to view these options:
● Move/Size: This option lets you select and adjust a single Gruen zone.
● Ruler: This option lets you measure the implant length. Click an endpoint of
the ruler ROI and move it to the desired location. The ruler should extend from
the implant tip to the shoulder of the implant. The Gruen Zones are positioned
vertically based on the implant length.
● Length: The Length tool lets you modify the length of the implant. The software
automatically calculates a length based on the automated ruler measurement.
The Length tool also includes a Find button which searches for the implant
edges based on the ruler position.
It is recommended that the top of Gruen zones 1 and 7 align with the shoulder of
the implant.
Orthopedic Knee Measurement and Analysis

Orthopedic Knee measurement and analysis provides an estimate of the bone mineral
density around knee implants pre and post-surgery. Reference data is not available
for Orthopedic Knee measurements.
This option is only available if you purchased the Orthopedic Knee option.
Orthopedic Knee Measurement

1. Remove all elastic wraps and bandages from the measurement region. Thick
bandages can interfere with the scan.
2. In the Exam list on the New Measurement screen, select Left Knee or Right Knee.
4. Be sure the patient is centered and square on the table. Use the centerline on the
scanner table as a reference.
5. The patient's arms must be crossed over the chest, away from the side of each hip.
6. Place the foam knee positioner under the knee of the leg to be scanned, with the
tapered end toward the patient's thigh.
7. Strap the foot of the leg to be scanned to the vertical side of the foot brace.
The leg should be in a neutral position, NOT rotated as in the femur scan.
8. Position the leg so the kneecap is straight up and the leg is parallel with the
centerline on the scan table.
9. Use the graphic on the New Measurement screen to adjust the position of the
laser light.
10. Position the laser light mid-shin, approximately 10 cm below the patella.
11. Select Start from the New Measurement toolbar to start the measurement.
12. Monitor the image to make sure:
a. (1) The scan is initiated 10 cm below the patella
b. (2) The tibia and femur are perpendicular to the scan path
c. (3) The scan continues 10 cm above the patella
Correct orthopedic knee image
the measurement.
Orthopedic Knee Analysis

2. If necessary, select Imaging from the Analysis tool bar to adjust the image.
3. Select ROIs from the Analyze toolbar to create and adjust the ROIs.
4. Use the Custom Analysis Tools (180) to create and adjust ROIs.
5. Select Results to view analysis results for each ROI created.
Knee bone points Knee neutral points Knee tissue points
on your changes.
The expected precision for knee BMD is 4-5% %CV depending on the size of the
ROI. Inspect each knee image and adjust points manually for optimal typing of
implant, bone, and soft tissue areas to obtain accurate BMD results.
Small Animal Measurement and Analysis

Small Animal measurement and analysis is for investigational use on laboratory
animals or for other tests that do not involve human subjects.
Proper cleaning and handling procedures must be followed
to prevent the possibility of cross-infection between subjects
scanned on the same system.
Clean and disinfect the system according to your local and
country-specific hygienic regulations. Protect table pad and
table top from wetness and prevent the ingress of liquid
into the scanner by protectively covering the scanner with
a waterproof non-attenuating material. Some plastics and
vinyls may have unique x-ray attenuation properties that
could affect results.
Small Animal Measurement

1. Make sure all attenuating materials (metal, etc.) are removed from the
measurement region.
2. Position the subject on the scanner table. Center the specimen on the center
line, placing the head toward the head end of the table, with the start a few
centimeters above the head.
6. If the image is not correct, select Abort, reposition the subject, and restart the
measurement.
7. To complete another measurement for the subject, select Set Up from the New
8. If you have completed measurements for the subject, select Home to move the
Small Animal Analysis

Both the bone and soft tissue images are shown when you open a small animal
body image for analysis. Changes you make to the cut positions on one image are
also made on the other image.
You can turn off the dual image option in the Tools > User Options tab. Refer
to User Options (236).
2. Select Imaging and adjust the image if necessary.
3. Make sure the small animal cuts are positioned as follows:
Small animal cuts
● (1) Head: The Head cut is located immediately below the chin.
● (2) Left and right arm: Both arm cuts pass through the arm sockets and are
as close to the body as possible. Ensure the cuts separate the hands and
arms from the body.
● (3) Left and right forearm: Both forearm cuts are as close to the body as
possible and separate the elbows and forearms from the body.
● (4) Left and right spine: Both spine cuts are as close to the spine as possible
without including the rib cage.
● (5) Left and right pelvis: Both pelvis cuts pass through the femoral necks and
do not touch the pelvis.
● (6) Pelvis top: The Pelvis Top cut is immediately above the top of the pelvis.
● (7) Left and right leg: Both leg cuts separate the hands and forearms from
the legs.
● (8) Center leg: The Center Leg cut separates the right and left leg.
4. If necessary, select ROIs and the Move Vertex tool (shown when you select ROIs).
Adjust the cut itself or select a vertex to adjust the cut position.
● Select the Move Vertex tool to position ROI vertices. Adjust the cut itself or
select a vertex to adjust the cut position.
● Vertex: Click on a vertex, then drag the cursor.
● Cut: Click on a cut (not a vertex), then drag the cursor.
6. If necessary, select Points to examine point typing.
7. Use the Adjust Threshold tool if necessary to adjust the threshold of the tissue
and bone point typing.
8. If you adjust point typing, select Results to view the analysis results based on
your changes.
9. Select Save to save your changes, or select Close and then No if you do not want
Small Animal Body Composition
Body Composition is part of the Small Animal Body analysis if you purchased the Body
Composition option. The program reports lean and fat tissue quantities.
Composition results are shown on the screen when you select the Composition tab
in the Analyze window. The program prints a Composition report if you select the
Composition report option in the Reports dialog box.
Use the cut positions to define the tissue regions. Adjust cuts as necessary to include
all of the tissue in the appropriate regions. Be very careful to separate the arm regions
from the tissue in the hips and thighs.
Refer to Custom Analysis (180) for additional analysis information.
Custom Analysis
Using custom analysis, you can create custom ROIs for image files. Custom Analysis
results are given in BMD, BMC, Area only. Reference data is not available.
Custom Analysis results are to be used for investigation purposes only.
1. Select an image file for analysis.
2. Select Imaging from the Analyze toolbar.
3. Adjust the image as necessary.
4. Select Custom from the Analyze pull-down menu.
5. Select ROIs from the Analyze toolbar.
6. Use the Custom Analysis tools (180) to create and adjust ROIs.
7. Select Results to view analysis results for each ROI created.
Custom Analysis Toolbar

Use the tools shown below to create custom ROIs for image files during custom
analysis. The tools are shown after you select ROIs.
Delete Selected ROI Click to remove an ROI. Click the ROI, then
click the Delete ROI icon.
Copy Selected ROI Click to copy the selected ROI onto the
current image.
Rotate ROI Click to rotate an ROI. Click an ROI, then

drag the cursor.
Move/Size ROI Click to move or size ROIs. To move
an ROI, click the ROI and then drag the
cursor. To change the size of an ROI, click
an ROI handle and then drag the cursor.
Create ROI Shape You can create four different ROI shapes:
Rectangle (shown at left), Circle, Ellipse, or
Polygon. Select a shape, click the image,
and then drag the cursor.
Create Line Click to create a Line ROI. Click the image,
and then drag the cursor.
Create Point Click to create a Point ROI. Click the image
and create a point.
Insert Vertex Click to add a vertex to an ROI. Click an
ROI and add a vertex.

Delete Vertex Click to remove a vertex from an ROI. Click
a vertex and remove it.
Move Vertex Click to move an ROI vertex. Click a
vertex, then drag the cursor.
Custom ROIs
Use the tools given below to perform special operations with custom ROIs.
To copy an ROI from one image to another, select the ROI(s) on the source image
and select the Save Custom ROI Template button. Give the ROI template a name
and select OK. Then select the destination image and select the Open Custom ROI
Template button. Select the template with the name you chose and press OK.
The tools are shown in the Analyze toolbar at the top of the Analyze window after
you select ROIs.
Set ROI Size Click to set the selected ROI's size to
specific dimensions.
Open Custom ROI Click to open a template from a previous

Template custom analysis.
Save Custom ROI Click to save the custom ROIs as a
Template template.
Precision Calculator
This section contains recommendations to assist in calculating the facility's DXA
precision error.
If you need to acquire scans for your precision study, be aware that local regulatory
policies often apply to such studies. Please consult the appropriate regulatory body
for more information.
The International Society for Clinical Densitometry (www.iscd.org) is a good resource
for information on precision and bone densitometry.
Precision Calculator Recommendations

● Create a new database to be used for the precision study only. Select the New
Database tool in the left panel below the More >> button. Assign the database a
new name. Refer to Database Maintenance (213) for more information.
● No imported scans should be included in your precision study database.
● You must follow the study criteria to utilize this tool:
￭ Use two scans per patient (30 patient minimum).
￭ Use three scans per patient (15 patients minimum).
● All scans must be analyzed using identical regions. If any patient in the study does
not match the study criteria, that patient is excluded from the precision calculation.
● If there are additional scans included for the patient, the calculator uses only the
most recent.
Precision Wizard
A Precision Wizard tool is available to assist the technologist in generating results from
the completed Precision Calculation study without additional spreadsheet tools.
1. Select Tools > User Options > Trending > Precision Calculator.
2. Select the Confidence Interval (95% is recommended).
3. Click the Wizard button.
4. Check one option:
● Use two scans per patient (30 patient minimum).
● Use three scans per patient (15 patients minimum).
5. Select the scan Sites and select the Regions to be evaluated.
You can select multiple items by holding the Ctrl key while clicking items.
6. Select the patients to include and click Next.
7. Select Next.
● If the selection does not meet the minimum number of patients, a warning
appears.
● If the selection meets the minimal requirements, a progress bar appears.
The Results tab is displayed, where each numbered tab represents a data set. If
two scans of 30 patients were done, only two numbered tabs are shown.
Results:
● BMD= Average BMD
● SD = Standard Deviation. This is the Precision Error in g/cm2.
● CV = Coefficient of Variation = SD / Mean in percent
● LSC = Least Significant Change at 95% Confidence Interval
8. At the bottom of the window, choose an output option:
● Select Export to save the results as a TXT file.
● Select Report to open the default printer window.
● Select Apply to apply the adjustment to the current database.
If Apply is selected, the SD of the precision study is included in the precision
footnote on the DXA report and used to calculate significant change for trend
results.
Custom Reference Population

You can create a custom reference population and use that population for comparison
to your patients' results. After you create or edit your custom reference population,
you can select it for analysis by selecting Tools > User Options > Reference Data tab,
and selecting the population from the drop-down list.
Invalid reference data may result in an incorrect comparison by the physician.
For T-score, the recommendation is a normative reference database of at least 300

healthy women between the ages of 20 and 39 with at least 150 subjects in each
decade from two or more geographically separated sites to assure that the test group
is representative.
For Z-score, the recommendation is that each ethnicity and gender database consist
of measurement results from at least 50 subjects per institution per decade for
the range of decades of interest (usually 20-80) from two or more geographically
separated sites to assure that the test group is representative.
Create a New Reference Population

1. Select Tools menu > Custom Reference Data.
2. In the Custom Reference Data Wizard, select New.
3. Enter a name for the new custom reference population, and then select OK.
4. Enter densitometry information, and then click Next.
5. Enter composition information, and then click Finish.
6. When finished, select OK.
Edit a Custom Reference Population

2. Select the population that needs editing from the list. Then, select Next.
3. Edit the existing custom reference data. When finished, select Finish.
Delete a Custom Reference Population

2. Select the population that needs to be deleted from the list. Then, select Delete.
3. To confirm the deletion, click OK at the warning prompt.
ScanCheck
ScanCheck (formerly known as CAD or Computer-Assisted Densitometry) assists the
user in detecting Spine, Femur, Forearm and Total Body abnormalities. ScanCheck
provides guidelines to minimize operator error through identification of potential
measurement and/or analysis errors. When potential anomalies are identified, helpful
instructions are displayed as well as multimedia help.
Apply your own knowledge and judgment to determine if there are any potential
problems with the image measurement or analysis.
When the ScanCheck tab is active, the identification of artifacts, incorrect analysis,
etc., is displayed to the right of the analyzed image. The ScanCheck tab gives the
technologist a checklist of items to confirm and/or correct during the analysis. The tab
includes a series of Yes/No questions with space for comments. Any ScanCheck item
can be disabled in Tools > User Options > ScanCheck tab.
ScanCheck Checklist
The ScanCheck checklist organizes ScanCheck items into three categories - Measure,
Analyze, Anatomy. Use these categories to analyze the image and make corrections
where necessary.
Click a ScanCheck warning to display a dialog with further instruction for correcting
the specific ScanCheck warning.
For AP Spine-Measure, the following items are verified:
● Scan mode is correct for patient thickness
● Spine is aligned with the centerline of the image
Example: ScanCheck is indicating a potential problem.
Patient thickness is outside the range for this mode.

If you click the blue hyperlink (Patient thickness...) the following dialog is displayed with
both a description of the problem detected and a recommended solution.
ScanCheck Assessor Example:
Description:
The wrong scan mode may have been selected for this patient's thickness.
Recommendation:
Consider rescanning the patient using the proper scan mode based on patient
thickness.
Hyperlinks are available for all ScanCheck indications with the yellow exclamation
point.
ScanCheck Check Rerun

The software automatically reruns ScanCheck checks if you recalculate results. You
can made modifications based on ScanCheck recommendations in the ROI or Points
screens.
ALWAYS manually review and consider any ScanCheck
findings.
Adjusting ScanCheck Thresholds

ScanCheck items can be disabled or adjusted in Tools > User Options > ScanCheck
tab.
Some aspects of the detection can be adjusted to be relatively more or less sensitive.
Decreasing the detection threshold will make the ScanCheck detection more sensitive.
Increasing the threshold will make the detection less sensitive. The Default button
returns the threshold to its original value.
Adjustable Thresholds
AP Spine
AP Spine Adjustment
ScanCheck
Heading
AP Spine Measure Spine does not appear to be aligned properly.
Angle threshold (degrees): 0-90
AP Spine Analysis Scan was started too low.
Scan Start Threshold (mm): 5.0-200.0
Scan was stopped too late.
Scan End Threshold (mm): 5.0-200.0
Bone area is substantially different from previous scan.
Bone area threshold (%): 0-100
AP Spine Anatomy Unusual high density areas detected.
Detection Sensitivity: 1.0-10.0
T-Score for an individual vertebra shows an unusual variation from
the L1-L4 T-Score.
Average T-Score variation threshold: 0.0-5.0
T-Score for at least one vertebra shows an unusual variation from the
T-Score of an adjacent vertebra.
Adjacent T-Score variation threshold: 0.0-5.0
T-Score for at least one vertebra shows an unusual variation from the
T-Score of another vertebra. T-Score variation threshold: 0.0-5.0
Unusual spine curvature was detected.
Angle (Cobb) threshold (degree): 0-90
Femur
Femur ScanCheck Adjustment
Heading
Femur Measure Femur shaft does not appear to be aligned properly.
Angle threshold (degree): 0-90
Poor femur rotation.

Lesser trochanter visibility threshold (mm): 0-10
Femur Analysis Bone area is substantially different from previous scan.
Bone area threshold (%): 0-100
Forearm
Forearm ScanCheck Adjustment
Heading
Forearm Measure Forearm does not appear to be aligned properly.
Angle threshold (degrees): 0-90
Directory Management
6
Move Scans
The Move option lets you move image files/exams from one patient record to another.
1. Select the image file you want to move.
Select more than one file by holding down the Ctrl key as you select files.
2. Select Move from the Directory toolbar.
3. Select the patient record to which you want to move the file.
If the patient record is located in a different database, select Change Database.
4. Select Next.
5. Select whether to replace the patient's information in the image file(s) you are
moving with the patient information you are moving the image file(s) to.
6. Select Finish.
Copy Exam Files

Use the Send Exam File feature to copy an exam file from the database to another
location.
If you purchased the TeleDensitometry kit, you can also use Send Exam File to email
exam files. See Email Exam Files (187).
1. Select the image you want to copy.
2. Select Directory menu > Send Exam File To, and select Disk.
A Compress Files prompt appears. The default is to compress files before copying
to disk. This allows more files to be included on a single disk.
You can choose to encrypt the files and enter a password.
The HIPAA Secure Copy option removes all patient information from the file.
3. Select OK.
4. Select the drive and folder to which you want to copy the file.
5. Select OK.
Email Image Files

If you purchased the TeleDensitometry kit, you can use the Send Image File feature
to email exam files.
1. Select the image you want to email.

2. Select Directory menu > Send Exam File To, and select Email.
A Compress Files prompt appears. The default is to compress files before sending.
This allows more files to be included. You can choose to encrypt the files and
enter a password.
The HIPAA Secure Copy option removes all patient information from the file.
3. Click OK.
The program opens a new email message and attaches the exam file to the
message.
Edit Patients or Exams

Use the Edit feature to update a patient record or exam file.
1. Select the item you want to edit, as follows:
● In the Patient list, highlight the patient record and click Edit on the Directory
toolbar.
● In the Exam list, highlight the exam or image and click Edit on the Directory
toolbar.
2. In the Edit Information dialog box, change the necessary information and click OK
To edit individual exam files, you must modify patient
information for each exam.
Delete Patients, Exams, or Images

Use the Delete feature to delete a patient record, exam, or image file. You can delete
just the patient, exam, or image record(s), or you can delete the record(s) and related
exam or image file(s).
1. Select the item you want to delete, as follows:
● In the Patient list, highlight the patient record and click Delete in the Directory
toolbar.
● In the Exam list, highlight the exam or image and select Delete in the Directory
toolbar.
2. At the prompt, select the appropriate option:
Option Description
Delete Selected Patient and Delete the selected patient in the Patient lists and
Associated Exams all images associated with the selected patient.
Delete Selected Exam Delete only the exam selected in the list.
Delete Selected Image Delete only the image selected in the list.
Delete Database Record Only (Recommended) Remove the patient and/or exam
record from the database.
Delete Database Record and Remove the patient and/or exam record from the
Exam File(s) database and permanently delete the exam file(s).
3. Click OK.
Change Image Type

The Change Image Type tool lets you change an image file to a different type (for
example, from a left femur to a right femur).
The image file must be closed before you can change the scan type.
1. Select the image you want to change.
2. Select Directory menu > Change Image Type.
3. Select the scan type to which the selected image should be changed.
4. Select OK.
Valid results are not guaranteed for images that were measured as the wrong site.
You should measure the patient again using the correct measurement site to ensure
accurate results.
Batch Exam File Operations

To export exam files as a batch to another location, DICOM, or the printer, follow
this procedure.
1. Select File > Batch Exam File Operations.
2. In the Export window, select Working or Archive as the Source Directory.
Change to another database to change the Working Directory.
3. Use the Filter By drop down menu to filter the Source Directory.
4. Select the exam(s) you want to export, or click Select All to export everything in
the Source Directory.
5. Choose HIPAA Secure Copy or Report:
● If HIPAA Secure Copy is selected, browse for a folder to save the file and click
OK.
● If Report is selected, choose Printer or DICOM from the Destination drop
down menu.
If you select Printer, a report is sent to the default printer based on the default
configuration.
6. Click OK.
Reporting
7
Reports
There are two types of reports:
● DXA Reports
● Composer Reports
DXA Reports
DXA reports contain data used by the physician for diagnosis. Each DXA report
uniquely identifies the patient and includes important information about the patient,
the DXA exam, and your product’s configuration. DXA reports can be modified, but
most of the information on the report is required for safe and effective use of product.
Modifications to the data or patient demographics in these
reports may change the patient diagnosis. Contact your local
GE representative if you have questions before modifying
reports or using advanced reporting features.
There are four standard sections in a DXA report:
Reporting
1. Heading and patient information

Contains the report heading and patient ID types, the patient's biographical
information, and the measurement and analysis dates.
2. Image and analysis information
Contains the image, reference graph, and results table. If the Trending option is
available and selected when creating the report, a trending graph and table will
appear in this section.
3. Comments
Contains information you entered in the Comments on the patient information
window.
4. Footnotes
Contains scan information, the reference population used for analysis, and
age-matched criteria.
Composer Reports
Composer reports contain physician-generated assessments and recommendations
based on data from the densitometer and the patient’s demographics, which can
assist the physician in communicating scan results to the patient and the patient’s
referring physician. Composer reports can be modified to facilitate communication.
Modifications to the data or patient demographics in these
reports may change the assessments and recommendations.
Contact your local GE representative if you have questions
before modifying reports or using advanced reporting
features.
Reporting
There are five standard sections in a typical Composer report:
1. Heading and Opening

Contains the report heading and the opening for a letter.
2. Patient Biographical
Contains patient biographical information.
3. Assessment
Contains exam results and the physician’s assessment of the exam.
4. Recommendation
Contains the physician’s recommendation.
5. Follow-Up
Contains the physician guidance on follow-up exam.
Report Center
From the Report Center, you can create and send reports to one or more selected
destinations, such as a printer or an e-mail account.
To access the Report Center, open an exam and click the Reports button on the
Analysis toolbar.
Create a Report
1. Open an analyzed exam.
Reporting
2. Select Reports from the Analysis toolbar.

The Report Center window is shown.
3. Under Select New Reports, select the check box next to each report you want to
create. If a report is not listed, you can use the Manage Reports window to add
more reports. For more information, refer to the Select Additional Reports (195)
section.
4. Change the report settings as necessary:
● Select Trending to enable trending on multiple exams.
● Click Open/Edit to preview or edit the selected report.
5. Configure the Destination and the number of Copies to print or send. You can
select more than one destination if desired.
Available destination options are Printer, Print-a-FAX, FAX, DICOM, HL7 and
Email. To send reports to these destinations, your organization must have the
appropriate equipment installed and have purchased the appropriate features
with enCORE.
If you send reports to the selected destinations often, click Set as Default. The
next time you open the Report Center, the destinations will be pre-selected for you.
6. Select Advanced to access additional options. HIPAA Secure Report, when
enabled, hides patient identifying information (name, ID, etc.) on any exam report.
7. Select Print/Send to print or send the selected reports. To cancel without printing
or sending, click Close.
Reporting
Select Additional Reports

Many reports are included with the enCORE software installation, but not all of these
reports are listed in the Report Center by default. When you are creating a report,
if you do not find the report you want, follow the steps in this section to make more
reports available in the Report Center list.
2. Select Reports from the Analysis toolbar. The Report Center window appears.
3. Select Advanced and click Manage Reports.
The Manage Reports window appears.
4. Select the report you want to be available. If the report is not listed, click Browse
and navigate to the appropriate style sheet folder. Delete will move highlighted
reports to the recycle bin. Restore System Reports will restore default system
reports. Custom reports will not be restored.
5. Choose Show only selected reports matching current exam content to only
show reports that will give results for the open exam (e.g., femur reports for
femur exams) or choose Show all selected reports to show all reports in the
Report Center.
6. Click Close to return to the Report Center. Verify that the report appears in the
Select New Report list as expected.
Reporting
Change an Assessment for a Report

The enCORE software allows you to save and reuse often-used written statements
that appear on reports. When you create a report, you can choose which pre-defined
statement to include with the report as an assessment, recommendation, or
follow-up. The steps in this section describe how to select and apply the statements
when creating a report.
For more information about creating and managing site-specific written statements
appropriate for reporting exam data, refer to the Assessment Editor (202)section of
this manual.
3. Select Advanced and click Assessments.
The Assessment window appears.
Reporting
4. Select the sites and assessment category types to be included on the report. The
site, type of assessment, and value for the site (region) are used to determine the
text for the assessment, recommendation, and follow-up.
You can configure enCORE to automatically select assessment sites, and you can
manually override the auto-selected sites:
a. Click Auto-Select.
In the Assessment Auto-Select window, configure how enCORE uses the
T-Score (Young Adult) and Z-Score (Age-Matched) values to automatically
select the assessment sites.
b. Click OK to return to the Assessments window.
Check marks appear for the assessment sites that enCORE automatically
selected.
c. If desired, you can manually override the auto-selected sites by clearing or
selecting the check boxes as needed.
5. Click OK to finish and return to the Report Center.
Configure Rules to Automatically Select Reports

Users can configure rules to automatically select reports based on specific criteria
(e.g., patient’s age, physician, etc.).
Reporting
3. Select Advanced and click Rules.

The Rules window appears.
4. Click New. Define the conditions under which certain reports should be selected.
5. Define as many rules as needed. Click Move Up and Move Down to organize the
list of rules in the order that the system should evaluate them.
6. If ISCD Official Positions are turned ON in Tools > User Options > Systems, the
Apply ISCD Rules check box is present. Selecting this box will select a specific
report for post-menopausal women and men over 50 years and a different report
for pre-menopausal women and men under 50 years. Click the Select ISCD
Reports button to configure ISCD reports.
7. Click OK to return to the Report Center.
8. Click Close to finish.
Optimizing the Report Center

Users can further optimize the Report Center for your organization’s work flows by
pre-selecting the most appropriate or most often-used report settings. For example, in
addition to tailoring the list of available reports, you also can customize:
● Whether reports are saved when the user clicks Print/Send
● Whether the Report Center window closes after the user clicks Print/Send
● The list of available monitoring and assessment regions
Reporting
Configure the Report Center Options

3. Select Advanced and click Options.
The Options window appears.
4. Configure the Report Center behavior as desired:

● Save reports on ‘Print / Send’. Automatically saves all reports that are sent
to a destination.
● Close Report Center on ‘Print / Send’. The Report Center closes automatically
when the user clicks Print/Send.
5. Click Modify to customize the sites and regions that are listed for either the
Monitoring Regions or the Assessment Regions. Monitoring Regions are regions
that will be used for trending on your report. Assessment Regions are regions that
will be used for the assessment on your report. If ISCD Official Positions are turned
ON in Tools > User Options > Systems, enCORE will automatically use the ISCD’s
recommendations for these regions.
6. To clear your configuration and reset the options back to the system default
settings, click Restore System Defaults.
7. Click OK to return to the Report Center.
8. Click Close to finish.
Style Sheets
enCORE software includes a style sheet designer that lets you create a personalized
physician report. You can create a new style sheet or edit one of the style sheets
provided.
Reporting
The style sheet editor works in a similar manner to any word processor with options
such as cut, copy, paste, and header/footer.
You can modify the sequence of assessments, comments, etc., and insert images and
tables in the report for easy editing and viewing.
You can open a default style sheet included with the software, make the necessary
modifications specific to your facility, and save the style sheet under a different name.
Create a New Style Sheet

1. Select Composer > Style Sheet.
2. Select New to create a new style sheet or Open to open an existing style sheet.
3. Enter the information you want to use in the reports that are created based on
this style sheet.
4. To use field codes in the style sheet, select the Field toolbar button and then
select the field code options.
5. Select the Save toolbar button to enter a name for the style sheet and save the
style sheet.
Style Sheet Toolbar Buttons

Icon Item
New Report (Ctrl+N)
Open Document
Save Report (Ctrl+S)
Print (Ctrl+Shift+P)
Print Preview (Ctrl+Shift+V)

Print Preview Wizard (Ctrl+Shift+W)
Spell Check (F7)
Insert Auto Text
Create New Auto Text
Edit Auto Text
Edit/Insert Field
Reporting
Icon Item
Close Report
Undo
Redo
Cut Selected Text
Copy Selected Text
Paste Text
Edit Headers and Footers
Switch Between Headers and Footers
Show Previous Header Footer
Show Next Header Footer
Set Header Footer Properties
Subreports
You can create style sheet subreports that can be inserted into multiple style sheets.
Subreports allow you to share common report sections across many style sheets, such
as a header, footer, or sections that may be enabled under certain conditions.
Create a New Subreport

1. Select Composer > Style Sheet > New Subreport.
2. Add content, such as text, images, or field codes.
3. Click the Save toolbar button. The Save As window appears.
4. Enter a unique file name and click Save.
5. Click the Close toolbar button to close the subreport.
Add a Subreport to a Style Sheet

1. Select Composer > Style Sheet > Open.
2. Select a style sheet from the list and click Open.
3. Place the cursor where you want to insert a subreport and click the Field toolbar
button. The Field Insert Window appears.
Reporting
4. In the 1-Category list, select Subreport.

5. In the 2-Filename list, select your subreport file.
6. In the 3-Display Rule list, select Always add subreport to unconditionally add the
subreport whenever a report based on this style sheet is created.
7. Click OK to close the Field Insert window.
8. Save your style sheet.
Configure a Subreport to Appear Only Under Certain

Conditions
To apply rules that govern whether a subreport is added when a report is created,
continue with the following steps.
1. Follow the steps in the section Add a Subreport to a Style Sheet (201).
2. Double-click the field code that contains the subreport. This opens the Field Edit
window.
3. Click Change (below the 3-Display Rule list). This opens the Rules Wizard window.
4. In the Rules Wizard window, in the area “What type of rule do you want to create?,”
select Conditionally add subreport.
5. Click Next.
6. In the area “What conditions do you want to check?,” select one or more
conditions that must be true in order to include the subreport.
7. Click Next to apply the inclusion logic and move to the next window.
8. In the area “Add any exceptions (if necessary),” select one or more exceptions to
apply to the rule logic.
9. Click Finish to save the rule and close the wizard. A summary of the rule appears
in the Field Edit window.
10. Click OK to close the Field Edit window.
11. Save and close your style sheet to finish.
Assessment Editor
1. Select Composer menu > Assessment Editor.
The Assessment Editor window is shown. The assessment categories are shown
on the left side of the window and the assessment graph is shown on the right.
The assessment graph is divided into sections called assessment boxes. The
program uses these boxes to assign an assessment to the patient's results. The
assessments that are appropriate for the patient's results are included.
2. Select the Category tab.
Select New to create a site-specific, type-specific, or gender-specific category.
Select Edit to change a category or Delete to remove one.
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3. Select the Text tab.

Numbered assessment boxes are shown on the assessment graph for the
currently selected category.
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4. Select the box for which you want to edit an assessment, recommendation, or
follow-up.
The current assessment, recommendation, and follow-up for that box is shown
on the left side of the window.
5. Edit the assessment.

Sample assessments are provided to help write your own assessments. The
sample assessments begin with the word (Sample) and appear on the summary
report as a Sample.
6. Select the Insert Field button to use field codes in the assessment. Field codes
automatically insert information such as a patient's birth date, the BMD of the
measured region, or today's date into the assessment.
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7. Edit the Recall Date as desired. Select the Recall option in either year(s) or
month(s).
The Composer Report can automatically add the Recall Date indicating the
recommended return appointment based on the measurement date and what
has been set up in the Assessment Editor screen.
8. Select the Breaks tab.
The Breaks tab in the Assessment Editor window lets you change the assessment
cutoffs by adding or removing the lines that define the boxes.
a. Add or remove break lines:
● To add a break line, select the location of the new break from the drop-down
lists on the left side of the window, and then select Set/Remove.
● To remove a break line, use the drop-down lists to select the location of the
line you want to remove, and then select Set/Remove.
You can also add and remove break lines directly on the assessment graph
by moving the mouse cursor over the assessment graph and clicking once to
add or remove a break line.
b. Select the Text tab to record assessments, recommendations, or follow-ups
for the new boxes.
Composer Database
You can create more than one Composer database. For example, if two doctors use
the same scanner, but they use different assessments, then the doctors should have
separate Composer databases.
Create a New Database

1. Select Composer menu > Database.
2. Select New.
3. Enter the filename for the new database.
4. Select Save.
Reporting
Change the Active Database

1. Select Composer menu > Database.
2. Select Open.
3. Select the database you want to use.
4. Select Open.
Practice Management Tools

Practice Management Tools are general-purpose business reporting tools for your
practice. Practice Management Tools include a list of templates to make the creation
of reports with conditions simpler.
Create a report by selecting Composer menu > Practice Management Tools. The
Practice Management dialog is divided into three areas:
1. Tools for adding, editing, and deleting queries (Add, Edit, Delete, Site/Region
Filters, History Catalog)
2. Available reports and their description (Select a Report)
3. Options for navigating through the Practice Management Tools wizard (Next,
Back, Cancel)
Available Reports
1. Select Composer menu > Practice Management Tools.
The Practice Management Tools (Select Report) window appears where you can
add, edit, and delete reports, as well as set BMD Site/Region filters (211) and view
the History Catalog (212).
The conditions defined here are used to produce the patient list when generating
a report.
2. Add (209), edit (211), or delete (211) a report query.
3. Click Next to advance to Available Report Types.
4. Select the Output format:
● Patient List (206)
● HCFA Form (208)
● Mail Merge (208)
● Chart (208)
Patient List Output
The Patient List option generates a list of all patients meeting the query criteria. Click
the Customize button to tailor the patient list output. Select one of three output types:
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Output type Description

Patient data only (Fast) Provides patient information (for example, biographical,
physician, insurance), but does not include exam data such
as T-score or BMD.
Patient data and most Provides patient information and most recent exam data.
recent Exam data Generation of this report may take extra time.
(Medium)
Patient data and full Exam Provides patient information and full exam history. Generation
history (Slow) of this report may take a long time.
You can perform these actions with a Patient List:

Sort By Click to sort by a column included in the report. Select
Ascending or Descending.
Add Patient Column Click to add patient biographical, physician, and/or

insurance information columns to the report output.
Click available columns to add to the report, and then
click OK
Add BMD Column Click to add most recent, lowest T-score/Z-score, and
site/region of lowest T-score/Z-score. Click available
columns to add to the report, and then click OK. This
button is only available when creating reports with the
most recent exam data.
Add Morph Column Click to add the lowest morphometry Z-score. Click
available columns to add to the report, and then click
OK. This button is only available when creating reports
with the most recent exam data.
Add Composition Click to add mass and %Fat columns. Click available
Column columns to add to the report, and then click OK. This
button is only available when creating reports with the
most recent exam data.
Configure Exam Click to add Exam values (Measure Date, Patient Age,
History Patient Height, Patient Weight, BMI, Skin Entrance dose)
or Densitometry (BMD, BMC, Area, T-score, Z-score,
Average Height, Average Width); Composition (Bone
Mass, Fat Mass, Lean Mass, Tissue Mass, Fat Free Mass,
Total Mass, Region, Percent Fat, Tissue Percent Fat, TBW,
ICW, ECW); and Morphometry (Anterior, Middle, Posterior,
Average Heights) sites/regions, AHA, and CoreScan
results.
Results are displayed to the same precision as on screen,
or to full precision (9 places past the decimal) if you
select the Show full precision option. Full precision does
not display the units of measurement, which facilitates
export to a spreadsheet program such as Excel.
This button is only available when creating reports with
full exam history.
Delete Column Select the column to delete, and then click Delete.
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HCFA Form Output

The HCFA Forms option generates a list of all patients meeting the query criteria. The
list can be printed directly to HCFA insurance forms, or exported to a text file.
Mail Merge Output
The Mail Merge option can be used to generate form letters or envelopes for mailing
lists. Save the file with a unique name in *.mmf format. After mailing lists are created
and saved, you can recall them using the Select Form button.
The form letters can be sorted by any field that is used in the mail merge form.
Chart Output
The Chart option shows a summary displayed as a pie chart. The chart can be based
on a wide selection of options such as treatment, lowest value, technician (attendant),
or referring physician. You can output the information to a file or printer.
The chart is based on these criteria:

Last Name Reading Physician Lowest BMD T-Score
City Attendant Site of Lowest BMD T-Score
State Insurance Company Region of Lowest BMD T-Score
Postal Code Indications Lowest BMD Z-Score
Country Treatments Site of Lowest BMD Z-Score
Gender Fractures Region of Lowest BMD Z-Score
Referring Physician
You can perform these actions with a chart:

● Click once on a particular cut (slice) to pull the cut from the pie graph and display
the details of that cut.
● To examine all the details of the chart, double click anywhere on the chart. A
complete list of the components and statistics appear.
● To save the chart, select Save This To History. Click Browse to choose the save
location.
The History Chart (212) is used to track saved pie chart trends over time. In order
to create a History Chart, multiple pie charts must be saved under one condition
or query heading.
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● Select Printer or File to output the information
Add a Query
The Practice Management Tools (Select Report) window appears, where you can
a report.
2. Select Add.
3. Enter a name for the query and a description for the report criteria.
a report.
Use a naming method for the reports that makes them easily identifiable. For
example, if you are creating a report that will include all patients over 50 that
have a T-Score of less than 2.0, the report could be named “Over 50 and T-Score
less than 2.0.”
4. In the Practice Management Tools Add Query window, select Add.
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5. In the Add Condition dialog box, select from the drop down menus for the
condition.
Only the conditions displayed are available (you cannot enter facility-specific
conditions).
6. Enter the criteria for the condition.

A list of conditions defaults to the And operator to combine the conditions listed.
However, you can select the Or operator, or define multiple conditions within
parentheses for multiple And/Or operations.
You can also edit and delete conditions by selecting a condition and clicking Edit
or Delete.
7. After completing all conditions for the query, click OK.

The created query is available for selection in the list of report types.
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Edit a Query
a report.
2. Select Edit from the Practice Management dialog to make modifications to the
name, description, or conditions associated with the report.
3. If desired, change the name of the report or the description associated with the
report.
Use a naming method for the reports that makes them easily identifiable. For
example, if you are creating a report that will include all patients over 50 that
have a T-Score of less than 2.0, the report could be named “Over 50 and T-Score
less than 2.0.”
4. Next, modify conditions associated with the report as desired, including the
criteria for each condition and how each of the conditions are handled. You can
add, edit, and delete conditions.
5. After all modifications are made, select OK.
The main Practice Management Tools dialog appears, highlighting the recently
edited report.
Delete a Query
a report.
2. Select the report to be deleted, and click Delete.
3. At the prompt, click OK to permanently delete the business report.
BMD Site/Region Filters

Reporting
2. Select Setup > BMD Site/Region filters for T/Z-score Queries to choose the sites
and regions for the T- and Z-score reports.
Expand the sites to display the available regions. Select sites and regions as
needed.
Click the Copy from Physician Reports button to use the Sites and Regions from
Composer.
History Catalog
1. Select Composer menu > Composer/Practice Management Tools.
2. Click the History Catalog button to view the History Chart.
In order to view a History Chart, multiple pie charts (208) must be saved under
one condition or query heading.
Database Maintenance
8
Database maintenance procedures are performed on the Directory screen (select
Directory from the Main screen or from the Common toolbar.
Options to complete database maintenance procedures are given in the Database
sidebar (see Screens and Toolbars (227)).
The Database sidebar includes the following database maintenance tools:
● Edit Database (214)
● New Database (216)
● Rebuild Database (218)
● Compress Database (213)
The database maintenance tools are not displayed by default.
Select the More>> button if you are unable to view the
database maintenance tools.
Compress Database
The Compress Database option lets you remove excess records that are left in the
database when you delete patient records. For performance reasons, these records
are left temporarily in the database.
The Compress Database option also performs a repair function on the database.
Large databases may take a long time to compress. In networked environments, run
the Compress utility from the closest proximity to where the database resides.
1. Select Compress Database from the Database sidebar.
The database maintenance tools are not displayed by
default. Select the More>> button if you are unable to
view the database maintenance tools.
The software displays a message when database compression or repair is

complete:
Compression of the Patient database successful.
If the program detects that it is necessary to compress the database, a message is
shown at program exit saying:
Compress the database to improve performance?
Select Yes to compress the database.
Delete Database
1. Select the database you want to delete from the Database sidebar.
2. Select Directory menu > Database Utilities.

3. Select Delete Entire Database.
A warning message appears verifying whether you want to delete the database.
Patient exam files are not deleted from the database
folder when you use the Delete Entire Database option.
4. Click OK to continue, or Cancel to abort the delete process.

5. When you select OK, the Delete Database dialog box gives these options:
● Just remove database connection: Removes the database name from the
database list, but does not delete the underlying database.
● Also permanently delete database: Removes the database name from the
program and deletes the underlying database.
Select one of the options and select OK.
Edit Database
Select the Edit Database option to perform the following tasks for the active patient
database:
● Change the name of the database.
● Modify which authentication method is used when the application connects to
the database.
● Refresh the current working folder where Exam files are stored.
● Modify the database’s archive or backup settings for the current workstation.
● Update the description of the database.
1. Select Edit Database from the Database sidebar.
The Edit Database window appears.
2. In the Name field, change the name of the active patient database. This name
appears in the list of databases shown in the Database sidebar.
3. Configure the authentication method. Specify whether the application uses

Windows authentication or SQL Server authentication when connecting to
the database.
● Windows authentication means you can connect to the database without
an additional login – the database will identify you by how you are logged in
to Windows.
● SQL Server authentication means you will specify a User ID and Password.
The User ID for the authentication method you select must also be set up in SQL
Server’s configuration. By default, SQL Server is installed with an account that has
UserID “sa” and password “lunar” This can be modified by installing Microsoft’s
SQL Server Management Studio and setting whatever authentication preferences
you choose.
4. The Folder field displays the name of the folder in which the Exam files are stored.
You cannot modify this location.
5. If you initially set up the active patient database with a working folder on a
non-shared drive and then later decided to share the drive and connect to the
same database from a different enCore workstation, you can refresh the working
folder by clicking the Refresh Working Folder for Mulit-User Database button on
the original workstation. Once the folder is refreshed on the original workstation,
you can return to the new workstation and connect to the database.
6. Click Archive / Backup Settings to open the Archive / Backup Database Settings
window and edit the following options:
Option Description
Allow Archive from this Change the archive permission for this workstation.
workstation A check in this box means archive is allowed on this
workstation. This setting is important if your files are
stored in a database that is used by several workstations.
Only one workstation should be used to archive all of the
files in the database. Do not allow files to be archived
from more than one workstation.
Allow Backup from this Change the backup permission for this workstation.
workstation A check in this box means backup is allowed on this
workstation. Every workstation should have its own
backup.
Perform Exclusive When you install a new enCORE software upgrade,

Lock and Backup you may need to upgrade your database the first time
when upgrading you connect to it. By default, this database upgrade
(recommended) process will lock the database and create a backup of the
database before proceeding with the upgrade. Clearing
this check box means that when an upgrade occurs,
enCORE will not do either of these steps. Clearing this
check box is not recommended unless your site has
special rules about client software performing backups.
Backup Folder Change the location of the folder that is used to back up
the software configuration and database files during an
upgrade. The specified folder must be on a drive local to
the server.
Use Database Folder Change whether the application stores the backup files in
(recommended) the same folder as the database files.
7. In the Description field, update the description of the database.
Export Database
The Export Database option lets you export results for all patients and exams in
the database to tab-delimited text files, which can be imported into a spreadsheet
program such as Microsoft Excel.
1. Select the database you want to export from the Database sidebar.
2. Select Directory menu > Database Utilities > Export.
3. Follow the steps on screen to customize the output.
4. In the Text File field, enter a path and filename.
This filename will be used as a prefix for the output files to be generated.
5. Click OK.
Results of all the patients and exams in the database are exported to tab-delimited
text files, saved at the path you specified.
New Database
1. Select New Database from the Database sidebar.
The New Database window appears.
2. In the Name field, enter the name of the new patient database to be used to
store patient records. This name appears in the list of databases shown in the
Database sidebar.
3. Specify information about the associated SQL server and SQL database:
a. In the Server Name field, update the name of the SQL server that hosts the
database. Or, if the current workstation hosts the database, select Local PC.
If databases are hosted on a shared drive, an
additional level of security can be provided by
installing Microsoft SQL Server Management Studio
and using that software to configure the server to
accept encrypted connections.
b. In the Database Name field, enter the name of the SQL database. Or, to use
the same name as specified in the Name field, select Use Same Name.
4. Configure the authentication method.
Select enCORE Default Authentication to use enCORE as originally installed and
without using security settings configured in SQL Server.
If you would like greater security on your database, first configure security settings
for the database in SQL Server and then specify in the New Database window the
authentication method that corresponds to those settings. To configure your SQL
Server database security settings, install the Microsoft SQL Server Management
Studio and use it to grant rights to specific Windows login accounts (Windows
Authentication) or to specific User ID and Password combinations (SQL Server
Authentication).
5. Click Archive / Backup Settings to open the Archive / Backup Database Settings
window and configure the following options:
Option Description
Allow Archive from this Change the archive permission for this workstation.
workstation A check in this box means archive is allowed on this
workstation. This setting is important if your files are
stored in a database that is used by several workstations.
Only one workstation should be used to archive all of the
files in the database. Do not allow files to be archived
from more than one workstation.
Allow Backup from this Change the backup permission for this workstation.
workstation A check in this box means backup is allowed on this
workstation. Every workstation should have its own
backup.
Perform Exclusive When you install a new enCORE software upgrade,
Lock and Backup you may need to upgrade your database the first time
when upgrading you connect to it. By default, this database upgrade
(recommended) process will lock the database and create a backup of the
database before proceeding with the upgrade. Clearing
this check box means that when an upgrade occurs,
enCORE will not do either of these steps. Clearing this
check box is not recommended unless your site has
special rules about client software performing backups.
Backup Folder Change the location of the folder that is used to back up
the software configuration and database files during an
upgrade. The specified folder must be on a drive local to
the server.
Use Database Folder Change whether the application stores the backup files in
(recommended) the same folder as the database files.
6. In the Description field, enter a brief description of the database. This description
appears in the Database sidebar for the active database.
7. Select OK. At the prompt, specify the working folder for the database. This is the
location of the exam files referenced by the database.
If working folders are maintained on a shared drive, an
additional level of security can be provided by setting
Windows permissions on those folders.
Archive
1. Select Archive to copy image files from your computer hard drive to an archive
location.
2. Select the archive method:
● Archive all exams for all patients
● Archive all exams for all patients in the current search results
● Archive all exams for selected patient
● Archive selected exam
3. Choose to copy or move the files:

The default archive process is to copy the image file to the archive location. The
original image file remains in the database directory.
When Move/Archive is used, the image file is moved to the archive location, and
then deleted from the local drive.
4. Refer to Edit Database (214) to change the destination for the archive drive.
5. Use the task scheduler found under Tools > Task Scheduler to set up automatic
archiving. Refer to Task Scheduler (221).
6. Select the More>> button to change the archive behavior and view these
advanced settings:
Option Description
Archive Style Choose Incremental to archive only those files that have
changed since the last archive operation, or Complete
to archive all files whether or not they were previously
archived.
Delete local file(s) after Delete all images from the original database location after
Archiving moving the images to the archive location.
Set as Default Advanced Set the archiving preferences you have chosen as the
Settings default.
Restore Backup
Restoring from backup also restores enCORE software settings and Composer style
sheets.
1. Select Directory > Database Utilities > Restore Backup.
2. Browse to the backup.zip file location.
3. Click OK.
If the file is kept on remote media, the software prompts for the appropriate
archive disk.
Rebuild Database
Import first, then rebuild.
The Rebuild Database option lets you rebuild (recreate) a database that has been
lost due to a computer hardware malfunction. You can also use this option to add
external files to the database.
You can rebuild the database from files that you have copied into the working
directory, or from files stored on an archive disk.
1. Select Rebuild Database from the Database sidebar.
2. To rebuild the database from an archive disk, select Archive as the Source
Directory Option. Otherwise, leave the Source Directory set to Working.
3. In the Filter By dialog box, select how you want the image files to be filtered.
4. Select the files you want to use to rebuild the database, or click Select All to use
all of the files.
Use the Ctrl key to select multiple images.
5. Select OK to rebuild the database.
Import Entire Databases

It is recommended that you create a new database before importing an entire
database, and that you enable the reference data under Tools > User Options >
Reference Data tab.
See Supported Import Options (220) for more information. Corrupted files/databases
or unanalyzed scan data are not imported. Morphometry, Small Animal, and Hand are
not available for import.
1. Create a folder on the enCORE computer directory to hold the import files.
2. In enCORE, select Directory > Database Utilities > Import.
3. To select the source database, first select the database type from the Source
Database list. To import from a recent enCORE database, select enCORE – SQL
Server. To import from an older enCORE database in lunar.mdb format, select
enCORE – Access.
For most database types, specify the specific database by clicking the … button
next to Source Directory, and navigating to the folder that holds the import data.
The import files are listed under Source Files. The exception is if you are importing
an enCORE – SQL Server database, in which case you must specify the specific
database by entering its name in Database Name.
4. Click OK.
Large databases may take more than an hour to import. Stopping the import
process by closing the application or rebooting the system will likely corrupt data.
Required Files for Database Import

Product File(s)
Hologic DOS Patient.dbf
Genscan.dbf
Hologic Windows Patscan.mdb
Lunar DPX-IQ, DPX-MD; Lunar Expert Region.dbf
Scan.dbf
Pbio.dbf
enCORE – Access (DPX NT, MD+, Lunar.mdb
Bravo/Duo, Prodigy series, iDXA series)
enCORE – SQL Server (DPX NT, MD+, N/A (Select database by server and database
Bravo/Duo, Prodigy series, iDXA series) name)
Norland XR26 all *.fil files additional service conversion
required
Import Database Manually

1. Select Directory > Database Utilities > Manual Import.
The Manual Import Wizard prompts you to select an existing patient from the
database.
If the patient is not in the current database, select New Patient.
2. Select Next.
3. Select the Image Source and Image Site from the drop down lists.
Refer to Supported Import Options (220).
4. Enter the measurement date of the imported scan.
5. Enter patient height and weight.
6. Select the calibration used, if necessary.
7. Select Next.
8. Enter the BMD values in the blank fields.
The converted value is displayed as you enter a value (if appropriate).
9. Select Finish.
The imported scan is labeled in the directory as a Manual Import.
Supported Import Options

Supported import options for manufacturers, scan types, and image files are
described here.
Manufacturers and Scan Types

X = Supported
NA = Not available
Hologic DPX-IQ, Expert, or Norland
enCORE
AP Spine X X X
Left/ Right Femur X X X
Dual Femur NA X NA
Forearm NA X NA
Total Body X X NA
Lateral/LVA Spine BMD NA X NA
Orthopedic Hip NA X NA
Hand NA X NA
Orthopedic Knee NA X NA
Norland files must be converted into Lunar format before

importing. This cannot be accomplished in the enCORE
software.
Image Support
The corresponding image files may be added to the database for viewing:
● DPX-IQ - AP Spine, DualFemur, Femur, Forearm, Total Body, and Orthopedic Hip
● EXPERT - AP Spine, DualFemur, Femur, Forearm, Total Body, Orthopedic Hip, and
Hand
When an image has been added, the directory provides the original file name.
Task Scheduler
When you select Tools > Task Scheduler, the Task Scheduler window appears. Use
these tools to add, edit, or delete a task.
Add Click Add to add a new task.
Edit Highlight the task to edit, and then click Edit.

This button is only available when a task is
available in the list.
Delete Highlight the task to delete, and then click Delete.
This button is only available when a task is
available in the list.
A Task window appears after you click Add or Edit. Complete the fields as described
below, and then click OK.
Field Description
Task Type the task name in the Task field, or click Choose from List
to select from a list of common task names.
Time Use the Time field to set the time for the task to be performed.
Every Use the Every field to set the task frequency. Choose Day(s),
Week(s), or Month(s).
When it's time for Click the When it's time for this task drop down menu to
this task choose the task action. Choose Prompt Me, Perform Archive
All, or Perform Backup.
Check Ask me before proceeding to receive a message
containing the Reminder Text before the task begins. Edit the
Reminder Text as desired.
SQL Server Database Interface

Requirements:
● The site must have Microsoft SQL Server (edition 2008, 2012, or 2014) or Microsoft
SQL Server Express (edition 2008 R2) installed on an available server. No special
installation is necessary on the client(s).
● The installed edition of Microsoft SQL Server must be 2008, 2012, 2014, or
Microsoft SQL Server Express 2008 R2. Some enCORE features are not compatible
with earlier releases.
● Unless the site is using Microsoft SQL Server Express 2008 R2, the site should
be familiar with how to install and configure SQL Server. GE Healthcare does not
support installation and configuration of the full version of SQL Server.
● The site also needs an account set up on SQL Server that has the authority to
create and modify databases (typically an administrator account), because enCORE
requires such operations for things like New Database, Backup/Restore, and so on.
Typical day-to-day operations can be done with an account that has much more
limited authority.
Network Speed
Expected network speeds for a database of 10,000 patients is approximately:
● Directory search for 1 patient = 1 second

● Directory search for all patients = 44 seconds
● Open single image (300KB Prodigy or 3MB iDXA) = 9 seconds
● Save single image = 23 seconds
Network Requirements
● Cat5-enhanced rated cables to handle Base100
● No external programs write/update the shared database
● No external programs read enCORE database while the enCORE program is
running on any system
● All systems sharing the database must be upgraded simultaneously.
External USB Hard Drive

An external hard drive connected via USB may be used with the enCORE system as an
archive and/or backup device. Contact your local GE representative for assistance.
The USB drive must be formatted as NTFS. Windows will automatically detect and
assign a drive letter when the external drive is plugged in.
Never unplug the USB drive while the computer is running, or without first disabling
the remote drive in Windows.
To control the drive assignment:
1. In Windows, switch to Windows Classic theme.
2. Navigate to Control Panel > Administrative Tools > Computer Management.
3. Open Storage > Disk Management.

4. Right-click the Removable Drive and select Change drive letter and paths.
5. Click Change.
6. Enter the drive letter to be used for archiving and click OK.
7. In enCORE, go to the Directory screen.
8. Select Edit Database.
9. In the Archive Drive and Backup fields, enter the drive letter.
Refer to Archive (217) for more information.
Troubleshooting
9
Troubleshooting
Point Typing Is Wrong
For example, bone edge lines do not follow bone.
Possible causes and remedies:
● If the point typing is wrong on less than 25% of the total image, see Advanced:
Adjust Point Typing (79). If more than 25% of the point typing is incorrect, the
quality of the results may be compromised.
● Patient has had a radiographic contrast study recently. Wait 72 hours after
contrast study before scanning.
● Wrong scan mode. Compare the Mode and Average Tissue Thickness from the
Analysis screen > Information tab with the Patient Thickness and Weight Limits
values for enCORE Measurement Modes (68).
Cannot Find Patient or Exam in Directory

● Patient scanned under wrong name. Search using Measured on date (see Search
(233).) If the exam is under the wrong patient, see Move Scan (187).
● Patient or exam deleted. See Rebuild Database (218).
ROIs Not in Proper Locations

● See Analysis Procedures (77).
● Wrong image type selected. See Change Image Type (189).
● Verify point typing is correct. See Advanced: Adjust Point Typing (79).
No Femur Total ROI

See Femur Measurement and Analysis (91). Ensure that the measurement includes
sufficient femoral shaft.
No Trending
Troubleshooting
● Trending (244) is not enabled. Check the Trending box under File > Print.
● Region not available on previous scan. Select a region available on the previous
scan.
For example:
￭ DualFemur trending Total Mean, but previous exam only has one femur
￭ AP Spine trending L1-L4, but previous exam has a vertebra excluded
Patient Data is Incorrect

Patient data includes ethnicity, gender, birth date, age, height, weight, etc.
See Edit Patients, Exams, or Images (188).
Wrong or No Reference Graph

● Ensure that a reference population is selected in Tools > User Options > Reference
Data
● Ensure patient demographics are correct
● Confirm current reference data selection by checking title on reference graph
and in footnotes on DXA reports
● If the reference graph is missing on a pediatric patient (age less than 20 years), the
Pediatric feature may not be enabled. Look in Help > About. If pediatric features
are not listed, contact your GE sales representative.
Error: Longitudinal Motion Failure. No Motion Detected.

Check for items behind the scanner that may interfere with the scan arm motion.
QA Fails
Perform another QA. If it fails again, contact GE Support or your GE distributor.
Screens and Toolbars
10
This section describes the screens and toolbars that are shown throughout the
program. Screens and toolbars provide the options to complete the procedures given
in this manual.
Using Screens
The screens provide information that lets you set up and complete measurements,
analysis, and quality assurance procedures. At the bottom of each screen, short
descriptions of procedures and alternative keystrokes are given to help you complete
a procedure.
Using Toolbars
The toolbars show icons representing tools, each of which let you complete a specific
procedure. To view a short description of a tool, hover the mouse pointer on the icon.
Patient Block
The Patient block is shown at the bottom of the Analyze, Directory, and New
Measurement screens. The Patient block gives information about the patient that is
being analyzed, measured, or is currently selected at the Directory screen. This is the
same information you record in the Patient Information dialog box or select from the
Patient list before starting a new measurement.
Help Text
Help text is located in the lower left corner of every screen in enCORE software.
The help text provides keystroke functionality, current operation of the system, and
instructions for the software user.
Main Screen
The main screen is the first screen shown when starting the enCORE software.
enCORE main screen
enCORE Forma main screen
Select from the options to access different areas of the program:

● Help (F1): View additional reference information about the scanner operation
● Measure (F2): Start a patient measurement
● Analyze (F3): Open a patient measurement for analysis
● Directory (F4): Work with patient files and perform database maintenance
procedures
● Quality Assurance (F5): Access the Quality Assurance (QA) screen
● Options (F6): Change the User Options and Connectivity Options settings, or view
the error log
● Exit (F8): Exit the program
Common Toolbar
The Common toolbar is shown on all screens.
Measure (F2 or Ctrl+M) Click Measure, then enter patient
information or select a patient from the
database to start a new measurement.
Analyze (F3 or Ctrl+A) Click Analyze, then choose an image file
for analysis.
Directory (F4 or Ctrl+D) Select Directory to work with patient files
and complete database maintenance
procedures.
QA (F5 or Ctrl+Q) Select QA to start a Quality Assurance test.
New Measurement Screen

The New Measurement screen is used to complete a new measurement for an existing
patient (already recorded in the database) or for a new patient. This screen is shown
when you select Measure from the Common toolbar.
A list of available measurement sites is presented on the New Measurement screen.
Select the measurement site from the Exam List, or highlight the measurement region
on the corresponding skeletal image.
Skeletal Image selections
New Measurement Toolbar

Home (F3) Click to move the scanner arm to the

Home position.
Set Up (F6) Click to return to the set up screen

and change the settings for the
measurement.
Also used to select a different
measurement type and start a new
measurement.
This tool is enabled after you select
Position.
Repeat (F4) Click to reposition the image and repeat
the measurement.
This tool is enabled after you complete
an exam.
Abort (F5) Click to stop the measurement and
then save, continue (resume), or start a
new measurement.
Start (F7) Click to start the measurement.
This tool is shown after you select
Position.
Position (F7) Click Position to move the scanner arm
to the start position, and then use the
controls on the scanner arm to position
the laser light for the measurement.
When you select Position, a graphic
is shown that illustrates the correct
patient and laser position for the
measurement type.
The laser is not used for total body
measurements.
Close (F8) Select Close to exit the New
Measurement screen.
Analyze When Done Option

Select the Analyze When Done option if you want to analyze the image file after the
measurement. When this option is selected, the Analyze screen is shown immediately
after the measurement is complete.
Home Scanner Arm

To move the scanner arm to the home position from any screen in the program, select
Home Scanner (Ctrl+H) from the Measure menu.
If the scan arm has been set to Home at the foot end of
the table, and the foam leg block is used for AP Spine
measurement, a warning will appear. Please remove patient
positioner.
Park Scanner
Select Park Scanner (Ctrl+K) from the Measure menu to move the scan arm to the foot
of the table (DPX-NT Mobile) or to the head of the table (Prodigy Mobile) for lockdown.
Analyze Screen
The Analyze screen is used to analyze image files. This screen is shown when you
select Analyze from the Common toolbar or the main screen, or when you select an
image file for analysis from the Directory screen.
In addition, this screen is shown immediately after a patient measurement if the
Analyze When Done option is selected on the New Measurement screen.
Analyze Toolbar
Select tools from the Analyze toolbar to complete analysis procedures (77). Refer to
specific scan types for detailed analysis recommendations for each measurement site.
General Analysis Tools
Imaging (Ctrl+I) Adjust contrast and zoom the image file.
ROIs (Ctrl+R) Position ROIs during analysis, and move

and size ROIs.
Points (F4) Classify bone and tissue samples.
Do not adjust point typing unless the
program made obvious errors.
Reset (F3) Resets the point typing, undoing any
manual changes.
This option is shown after you select Points.
Copy (F5) Copy ROIs from an existing image file to
the current image file.
Cancel (Esc) Ignores any changes you made.
This option is shown after you select ROIs
or Points.
Results (Enter) View analysis results for the image file.
This option is shown after you select ROIs
or Points.
Report (Ctrl+Shift+P) Create analysis reports for the image file.

Save (Ctrl+S) Save the image file and data to the patient
database.
Close (Esc) Close the image file.
ROI Tools
Delete ROI Delete an ROI.
Move ROI Move an ROI.
Rotate ROI Turn an ROI in a circular motion.
Add ROI AP Spine: Add an ROI. When you add a

new ROI, it is inserted below the currently
selected ROI.
LVA Spine Geometry and APVA Spine
Geometry: Add an ROI. When you add a
new ROI, select the desired ROI from the
menu.
Move Vertex Move a vertex of an ROI.
Label ROIs Label an ROI.
Results Tabs
The Results tabs on the Analyze screen let you review BMD, reference, trend, and
composition results. To change default settings for graphs, reference data, and results
tables, refer to Options (243).
The following Results tabs are available:
● ScanCheck tab: Provides a checklist of potential measurement and/or analysis
errors.
● Densitometry tab: Provides BMD, BMC, Area, and reference results.
● Trend tab: Provides results trending over time.
● Information tab: Gives information related to the scan parameters.
● Composition tab: Provides Total Body composition or Spine/Femur estimated
composition results.
● AFF tab (Atypical Femur Fracture): Provides measurements of the lateral cortex
along the femoral shaft such as cortical width and beaking index, which can be
trended across serial scans.
● AHA tab (Femur Advanced Hip Assessment): Provides information about hip axis
length, hip strength, and hip geometry results.
● Morphometry tab: Provides vertebral heights and ratios.
Directory Screen
The Directory screen is shown when you select Directory from the Main screen or
from the Common toolbar. This screen lists the patient files and exams that are stored
in the active database.
The Directory screen is divided into four areas:
1. Search option
2. Patient list
3. Exam list
4. Database sidebar
Search
Use the Search option to quickly locate a patient record and exam file in a large
database. The Search option is located near the top of the Directory screen.
1. Select the database field to use in the search.
2. Enter the patient information to use in the search.
3. Select Search.
The patient record and associated exam files are shown in the Patient and Exam
lists.
Use the All Patients button to clear the search criteria and list all patients in the
database.
Directory Toolbar
Edit (Ctrl+E) Edit Primary, Secondary, and Additional patient
data. Opens the patient record if a patient
is currently highlighted in the Patient List, or
opens an exam record if an exam is currently
highlighted in the Exam list.
Editing the patient record does not save the
updated information to exams that have
already been acquired for that patient.
New (Ctrl+N) Enter a new patient that is not in the patient
database.
Delete (Del) Delete the highlighted patient, exam, or image.

You can delete the patient, exam, or image
database record(s) only, or the database
record(s) and related exam files.
Move (F4) Move the highlighted exam(s) to another
patient record.
Archive (F5) Copy or move exam files from the computer

hard drive to an archive location. You can
archive single exams, single patients, or all
patients. You can also archive all exams for all
patients found during a search.
Close (Esc) Exit the Directory screen.
Patient List and Exam List
Patient List
Use the Patient list to select a patient to measure. Double-click a highlighted patient
record to start a new measurement.
The Patient list shows patient records in the database according to the patient’s last
name, first name, ID, and birth date. The patient information for the selected patient is
also shown in the Patient block at the bottom of the Directory, New Measurement,
and Analyze screens.
Exam List
Use the Exam list to select an exam to analyze. Double-click a highlighted exam to
analyze the exam. The Exam list shows the patient measurements in the database
according to measurement type, date measured, date analyzed, file name, and
archive label. The Exam list may include exams made up of multiple images.
Assign a status or notes to an exam by right-clicking the exam in the directory and
selecting Change Status or Notes. Choose from a list of five status types:
Icon Status
No icon Not Reviewed
Pending Review
Rejected
Approved
Closed
Enable Exam Status/notes features and set defaults, actions when sending a report,
and status colors under Tools > User Options > Directory tab > Directory Status
button.
Database Sidebar
The Database sidebar shows the database that is currently being used (active
database) and the working path of that directory. If you do not see this information,
select More >>.
The Active Database panel indicates the location of the database and the drive used
for archiving patient studies. Most systems use a hard drive location for the working
path and a removable media drive for the archive drive. This information is always
available on the Directory screen.
All databases are listed on the database sidebar. Creating more than one database
is especially useful for customers performing research studies. The currently active
database is highlighted in the available databases list. To change databases, highlight
the desired database in the list.
The lower portion of the Database sidebar shows all available databases, and
database maintenance options.
Database maintenance tools provide the ability to edit, create, rebuild or compress the
database. Refer to Edit Database (214), Compress Database (213), Rebuild Database
(218), or New Database (216).
Quality Assurance Screen

The Quality Assurance screen is used to complete a Quality Assurance (QA) procedure.
This screen is shown when you select Quality Assurance from the Main screen or
from the Common toolbar.
Quality Assurance Toolbar

Trend (F2) QA trending history is automatically shown
after a QA procedure (unless you have changed
this in User Options). If the trending history is
not shown, you can select Trend to view the
QA trending history after you complete the QA
procedure.
Settings (F3) Select to change information for trending.
Report (Ctrl+P) Select to create a report of the QA results.
Abort (F5) Select to stop the QA test.
Start (Enter) Select to start the QA procedure.
Close (Esc) Select to exit the QA screen.
System Status
The Quality Assurance screen indicates the current operating status of the system.
To ensure accurate results, the System Status should indicate System is ready to
measure patients before performing patient measurements.
System status
Refer to Quality Assurance (59) for instructions on performing QA procedures.
Options
Select Tools from the Main menu to access User Options (236), Connectivity Options
(250), or the Error Log (252). These options are also available from the Options button
on the Main screen.
User Options
User Options let you set and change the program’s default settings.
1. Select Options (F6) from the Main screen and select User Options.
OR
Select Tools menu > User Options.
2. Change the settings as necessary.
3. Select OK to save changes. If you do not want to save changes, select Cancel.
Systems Scanner’s system ID number and feature code,

User Interface Options, and ISCD settings.
If the Automatic return to Directory option is
selected, enCORE returns to the Directory screen
instead of the Main screen when you close
windows.
The Auxiliary Workstation option is shown if you
purchased the Multi-User Database kit. Select
to prevent this workstation from performing QA
procedures or patient measurements.
The Number of Open Exams option lets you
choose how many exams can be opened for
analysis at the same time.
Directory Determine how information is sorted in the

Patient and Exam/Image lists, and to configure
default ethnicity. You can also choose to expand
exams by default.
Analyze Enable/disable analysis features for all scan types.

You can also choose the type of Small Animal
calibration to use, and the type of forearm
calibration to use for BMD results.
Results Display Change the appearance of graphs (Standard,

WHO, JSBMR, or NHANES Total Body). Select the
information shown in the results tables and select
the composition results to show.
Trending Select the type of information shown on trending

graphs and in trending tables, and configure
the software to flag significant change. The
integrated Precision Calculator tool is also located
here.
Reference Data Select a reference population, show the reference

sources on-screen and in results reports, and set
the morphometry SD cutoffs. Use of the reference
population comparisons is fully at the discretion
of the clinician. The program does not show
the comparative values when shipped from GE
Healthcare.
Image Set the colors of ROIs, bone edges, and point

typed areas of an image file during analysis, and
enable optimal image magnification.
ScanCheck Select which ScanCheck checks to in include on

the ScanCheck tab for AP Spine, Femur, Forearm,
and Total Body analysis.
Reports Under DXA Report Configurations, select to Trend

Multiple Results, Invert Image, Show Comments,
and Show Ethnicity.
User Information includes site name, address,
phone numbers, web site and email information.
Also configure Spelling Options, PDF Export
Security Settings, and whether to display ICD9
or ICD10 codes with Fractures, Indications and
Treatments.
QA Use this option to change the default setting for

printing QA reports.
Select Automatic Printing: Daily QA to have
the program print a QA report each time you
complete a quality assurance procedure.
Select Automatic Return to Trend Screen to
automatically return to the trend screen after QA
has completed.
Measure Set the defaults used during measurements:
● Save Prompt at End of Scan (select this option

to show a message after every measurement
that asks whether to save the measurement),
● Allow Continue after SmartScan Abort
● Use Old Positioner for Lateral Measurements
(densitometry and morphometry only)
● Show Previous Scan
● Allow Scanner Start Button to Initiate a
Measurement
● LVA Reverse (for LVA, scan patient facing foot
of table)
● Default to Seated Patient for Forearm and
Hand Scans
● Pause between Femur scans
● OneScan (no foam leg block positioner for AP

Spine scans)
● Pause between AP Spine and Femur Scans
Systems Tab
The scanner's System ID is unique. The System ID is needed for support.
Feature codes are only compatible with a specific system ID, and enable purchased
options in the software. To try a feature before buying it, contact your sales person
for a trial feature code.
Additional Feature Enter Trial and IRB feature codes.
Codes Expiration dates are displayed below each
feature code.
User Interface ● Automatic Return to Directory returns the
Options display to the Directory screen (rather than the
main screen) after a measurement, analysis,
or QA is completed
● HIPAA Secure View hides patient information
on the Directory screen.
● Play Multimedia Sounds enables sound for
multimedia content.
● Auxiliary Workstation is for use with MUDB
(Multi-User Database) setups. Select this
option to prevent the workstation from
performing QA procedures or patient
measurements. The Auxiliary Workstation
option is shown if you purchased the MUDB
feature. The Number of Open Exams option
lets you choose how many exams can be
opened for analysis at the same time.
Exam File Options ● HIPAA Secure Filename removes patient
name information from the scan file name.
● HIPAA Secure Filename Off:
SmithJf0m485s.dff
● Compress Exam Files compresses exams to
conserve space for high resolution images
such as iDXA scans.
● Encrypt Exam Files encrypts files so the file
information cannot be viewed with other
applications.

ISCD Official Select Yes to apply the settings recommended
Positions by ISCD.
When the ISCD Official Positions are applied, the
following settings are in effect:
● USA (Combined NHANES/Lunar) reference
population
● Calculate male and female Young Adult
(T-score) using Caucasian female reference
population “USA (Combined NHANES/Lunar)”
for sites: AP Spine, Femur, Forearm
● Calculate results using reference population
“USA (NHANES 1999-2004)” for Total Body
(NOTE: Only available for United States)
● Z-score weight adjustment disabled
● WHO graph and WHO classifications applied
for postmenopausal women and men age 50
or greater only
● Default ROIs for reporting:
￭ AP Spine - L1-L4
￭ Femur - Neck, Total
￭ Forearm - Radius 33%
￭ Total Body Pediatric - TBLH
● Default trend table data columns:
￭ Change vs Previous (difference)
￭ Change vs Previous (%)
● Flag significant changed enabled
● Default Composer assessment based on
lowest T-score of AP Spine L1-L4, Femur Neck,
and Femur Total regions
● Default to Composer Densitometry Plus
T-score report for postmenopausal women
and males age 50 or greater
● Default to Composer Densitometry Plus
Z-score report for premenopausal women and
males younger than age 50
● ScanCheck AP Spine Adjacent T-score rule
enabled
Review current ISCD positions using the link in the
enCORE software.

FRAX Select Enable FRAX and/or Apply US NOF/ISCD
FRAX recommendations.
Review the NOF/ISCD FRAX Implementation
Guide using the link in the enCORE software.
Security Settings ● Disable All turns off all security settings.
● Limit Functionality based on user role
restricts what functions users can perform
based on assigned Windows login group.
● Verify Digital Signatures for Composer
reports requires user confirmation of identity
(password) prior to applying electronic
signatures to Composer reports.
● Configure Limited Functionality defines the
functions each login group can perform.
Directory Tab
Patient Sort Sort by First name, Last name or Patient ID.
Options Sort Ascending or Descending.
Exam Sort Options Sort by Measurement, Date Measured, Date
Analyzed, File Name, Archive, Import, or Status.
Sort Ascending or Descending.
Patient List Choose Patient Third column contents: Patient ID,
Columns Facility ID, Department ID or Exam ID.
Directory Rules Select the Default Gender and Default Ethnicity.

and Defaults Configure Login Timeout. This should remain
set to 15 unless you are experiencing network
problems that specifically mention a login timeout
error, in which case you may want to increase
this setting.
Configure whether to restrict Duplicate Patient
matches to Patient ID only. enCORE will evaluate
patient name, birth date and patient ID by default.
Select whether to Expand Exams by Default.
When this option is selected, the Exam folders
in the Directory automatically show exams for
selection.
Directory Status Enable Exam Status/Notes features. Set default
status, actions when sending a report, and status
colors.
Analyze Tab
Femur Analysis AHA: Hip Axis Length, Upper Neck region, Lower
Options Neck region.
Calculate Hip Strength results and Hip Geometry
results.
AFF:
Enable display of AFF results for proximal only
femur images.
Change the threshold used to display an arrow
where the maximum beaking index is located on
AFF tab of femur images.
Total Body Analysis Calculate Left and Right results.

Options
Calculate Total Body Less Head (TBLH) result (used
for Pediatric)
Set Basic or Enhanced analysis default for Prodigy
exams (see Enhanced Total Body Analysis (121))
and whether to prompt when opening Prodigy
exams previously analyzed with a different
analysis type.
Forearm Analysis Forearm Calibration: Lunar, SPA or Comac

Options
Ortho Hip Analysis Standard Gruen zones or Extended Gruen zones

Options
Small Calibration: Chemical/Ash or Lunar

Animal/Research
Options
Morphometry Create ROIs on Request (Recommended)

Options
Automatically create Reference ROIs when
needed
Automatically create ROIs for T8-L4 when opening
exam
Finish Button Finish Button On/Off. Operations to perform:

Options Open Report(s), Send Report(s) to destinations,
Save Exam, Close Exam.
NA Estimated Total On or off. Estimate % Body Fat from Spine/Femur

Body exam.
Results Display Tab

Reference Graph ● Young Adult (YA) Bars: Standard, WHO, or

Options JSBMR.
● Show Y2-axis values.
● Age-Matched (AM) Bars appearance and SD
applied.
● Graph (Reference Only or Reference with
BMD/BMC) and NHANES Total Body
Densitometry Table ● Young Adult (YA) in % or T-Score, Age-Matched
Options (AM) in % or Z-Score.
● Show BMC, Show Area, Show Diagnostic
Category Icons.
Composition ● Z-Score or Centile results.
Options
● Metric or English measurement system.
● Composition graph breakpoints and colors.
BMI Options ● BMI cutoff points assigned per WHO or
Custom.
● BMI On or Off.
Metabolic Options Enable display of metabolic information,
and choose method of calculating RMR
(Harris-Benedict, Mifflin-St Jeor, or manually
entered).
NA Densitometry BMD or BMC
Pediatric Reference
NA Composition Tissue %Fat or Region %Fat
Reference
Trending Tab
Trend Graph Select Line Pattern, Densitometry Trend Graph
Options (Percent Change or Reference), Morphometry
Trend Graph (Percent Change or Absolute Value),
or Composition Trend Graph settings.
Trend Table Flag Significant Change On or Off. Configure
Options how trending is to be displayed.
Precision Precision Tool to determine the SD and Least

Calculator Significant Change (LSC) for the facility for scan
types AP Spine, Femur, DualFemur, Total Body,
Forearm, Hand and Lateral Spine.
N/A Trend On Results Select Densitometry Pediatric, Densitometry
Adult, Morphometry, Composition Y1 axis,
Composition Y2 axis, Estimated Composition
Trend, Pediatric Growth Trend, Composition, and
Ped Growth Y1 axis.
Reference Data Tab
Reference ● Choose country-specific reference

Population Options populations for each site.
● Configure reference settings for each site.
Morphometry ● Morphometry analysis technique in Z-Score

Reference Options or Percent Height Reduction.
● Mild, Moderate, and Severe deformity cutoffs.
Reference Population Options
Item Description
Sites — Selected Choose country-specific reference populations for each

Reference Populations site.
AP Spine, Femur, LVA, Total Body, Forearm, Lateral Spine,
Pediatric AP Spine, Pediatric Femur, Pediatric Total Body
Available Reference Available reference populations are: Asia, Australia

Populations (Combined Geelong/Lunar), Australia (Geelong), Australia
(Lunar), Brazil, China, Egypt, Finland, France, Germany,
Indonesia, Italy, Japan (JSBMR 2011), Japan (JSBMR
2012), Japan (Lunar), Korea, Mexico, Middle East,
Philippine, Spain, Tunisia, Turkey, UK, USA (Combined
Item Description
BMDCS/Lunar), USA (Combined NHANES/BMDCS/Lunar),
USA (Combined NHANES/Lunar), USA (Lunar), and USA
(NHANES 1999–2004).
Use Same Reference Enable to select the displayed reference population for
Population for All Sites all sites.
Disable to select different reference populations for each
site.
When this option is enabled, if a Reference Population
has been assigned to a site that it does not support, then
(Not Supported) appears for that site. When this option
is not enabled, the Available Reference Populations list
shows only the Reference Populations that support the
currently selected site.
Calculate male If checked, for AP Spine, Femur, and Forearm exams

and female Young always use Caucasian female USA (Combined
Adult (T-score) using NHANES/Lunar) reference population regardless of the
Caucasian female gender of the patient. This option is recommended by
reference population ISCD.
“USA (Combined
NHANES/Lunar)”’ for
sites: AP Spine, Femur,
Forearm
Default Region Choose the region to be the default region for analysis
for each scan type.
Reference Settings Young Adult (T-score), Age Matched (Z-score), Ethnic

adjustment, Height adjustment, Weight adjustment.
Set All Click Set All to enable all of the reference settings.
Morphometry Reference Options
Item Description
Morphometry Analysis Enable Z-scores or Percent Reduction (%).

Technique
Cutoffs Enable Mild, Moderate, or Severe deformity cutoffs and

specify cutoff values for each.
Image Tab
N/A Image Options Turn on or off: Interpolate, Invert Image, Show bone
edges, Show Artifacts, Size Image to Fit Screen
on Open, Display two Total Body images, Display
DualFemur Images top/bottom, Display Composition
Image for Total Body.
Image Colors Change image colors for ROIs, Zoom Region/Masks,
Bone Edges, Point Typing, Markers, Artifacts, Bone
Color Mapping, Tissue Color Mapping (iDXA only).
Air Color Screen:
● Standard: Makes air/unscanned pixels black if
Inverse is set to Off, or white if Inverse is set to On.
● Transparent: Makes air/unscanned pixels the
same color as the Windows background.
● Color: Makes air/unscanned pixels a user-selected
color. Click in the color rectangle, and choose the
desired color from the color selection dialog.
Air Color Print:
● Standard: Makes air/unscanned pixels black if
Inverse is set to Off, or white if Inverse is set to On.
(Printing has Inverse set to On by default.)
● Transparent: Makes air/unscanned pixels white
on the printout.
● Color: Makes air/unscanned pixels a user-selected
color. Click in the color rectangle, and choose the
desired color from the color selection dialog.
Color Coding Spectrum defines the colors displayed
on Total Body images when the Color Coding option
is selected.
Total Body color options:
● Default Tissue Colors defines which of the three
color options is displayed when initially opening
a new Total Body image: Black and White, Color
Coding, or Color Mapping (iDXA only).
● Color Coding Defaults are the %Fat values where
the Image contrast bars will be placed. These
settings map to the Color Coding Spectrum,
effectively identifying which colors apply to which
%Fat values. These are only the defaults, and
may be modified on the Image Tools dialog for
each image.
Image Export JPG Quality from 10 to 100, where 10 is the lowest
Options quality and 100 is the highest.
Morphometry LVA Wizard Zoom Margin, in millimeters.

Wizard Options
ScanCheck Tab
At the top of the screen, select whether to enable ScanCheck, and whether to default
to ScanCheck tab (show ScanCheck tab first when analyzing).
At the bottom of the screen, select whether to include ScanCheck indications on
reports.
In the sections labeled AP Spine, Femur, etc., use the checkboxes to select which
ScanCheck items to show on the analysis screen.
AP Spine
AP Spine Detect the following problems:
AP Spine–Measure Correct scan mode used?
AP Spine alignment reasonably straight?
AP Spine–Analyze Optimal contrast and brightness set?
ROIs properly defined?
L1-L4 labeled correctly?
Tissue region properly defined?
Bone edges properly defined?
Results consistent with previous scan?
AP Spine–Anatomy Analysis region free of unusual high density bone?
Free of unusual T-score variation?
Free of unusual curvature?
AP Spine–Comments Comments
Femur
Femur Detect the following problems
Femur–Measure Correct scan mode used?
Sufficient pelvis and shaft separation?
Femur shaft reasonably straight?
Proper femur rotation?
Femur–Analyze Optimal contrast and brightness set?
Results consistent with previous scan?
Femur–Anatomy Analysis region free of unusual high density bone?
Femur–Comments Comments
Total Body
Total Body Detect the following problems
Total Body–Measure Correct scan mode used?
Patient within scan field?
Total Body–Analyze Optimal contrast and brightness set?
Patient Height Entered Correctly?
Patient Weight Entered Correctly?
Total Body–Anatomy Analysis region free of unusual high density bone?
Total Body–Comments Comments
Forearm
Forearm Detect the following problems
Forearm–Measure Forearm alignment reasonably straight?
Forearm–Analyze Optimal contrast and brightness set?
Forearm–Anatomy Analysis region free of unusual high density bone?
Forearm–Comments Comments
Reports Tab
Report Trend Multiple Results Only, Invert Image, Show
Configuration Comments, Show Ethnicity.
Report Colors Change the default colors of report header

sections.
User Information User Information will be used as a header for

all DXA reports.
Spelling Options General options, Spelling Suggestions, Dictionary

or Customized Dictionary, Advanced Settings,
and Performance and Accuracy settings.
PDF Export Security Add password protection to exported PDF
Settings documents.
Set permissions for printing and editing.
N/A Display ICD-9 or Turn on or turn off ICD-9 or ICD-10 codes.
ICD-10 codes
with Fractures,
Indications and
Treatments
QA Tab
N/A Default QA Copies Number of QA Report copies.
N/A Automatic Daily QA Automatically print QA report after QA
Print procedure is completed.
N/A Automatic return to Automatically return to QA trend screen
trend screen after QA procedure is completed.
N/A Graphical Interface Display QA test graphics.
N/A Enable QA stability Enable relative mean and rolling
analysis standard deviation checks of QA test
values.
N/A Compress Patient Automatically compress patient

Database after QA database after QA procedure is
completed.
N/A Allow QA Block scans Allow scanning QA Block from Measure
outside of Daily QA screen.
QA Means Reset QA test mean values.
QA AutoMentor Enable AutoMentor to automatically

email or fax QA report if QA fails.
Measure Tab
N/A Save Prompt at end of scan Display a message after every measurement
that asks whether to save the measurement.
N/A Allow continue after Allows resuming aborted measurement.
SmartScan abort
N/A Show Previous Scan Show previous patient scan during new
measurement.
N/A Allow Scanner Start Button Allows starting a scan using the Start button
to initiate a Measurement on the scan arm (iDXA only).
N/A Use Old Positioner for Select appropriate Lateral positioner for the
Lateral Measurements site.
(Densitometry and
Morphometry only)
N/A LVA Reverse (for LVA, scan Measure patients lying on right side rather
patient facing foot of table) than left side.
N/A Default to Femur Detail (Prodigy and DPX only) Enable to use Detail
mode mode for femur measurements.
Disable to use Standard mode for femur
measurements.

N/A Default to perform Distal Enable to perform distal and proximal scans
and Proximal scans for AFF for femur measurements.
Disable to perform only proximal scans for
femur measurements.
N/A Default to seated patient Enable to use seated positioning for forearm
for forearm and hand scans and hand measurements.
Disable to use supine positioning for forearm
and hand measurements (Prodigy and iDXA).
N/A Pause between Femur Enable to view left femur measurement before
scans proceeding to right femur positioning.
Disable to proceed directly to right femur
position screen after left femur measurement
is completed.
N/A OneScan (don't use Foam Perform AP spine and DualFemur exam
Leg Block positioner for AP without repositioning between scans.
Spine scans)
N/A Pause between AP Spine Enable to view AP spine measurement before

and Femur scans proceeding to left femur positioning.
Disable to proceed directly to left femur
position screen after AP spine measurement
is completed.
This pause will always occur when performing
distal and proximal scans for AFF
Joystick Options Adjust speed of transverse and longitudinal
scan arm movement during manual
positioning.
Download Download scanner firmware (Service tool).
Connectivity Options
Connectivity options let you change report delivery, fax, email, DICOM, and HL7 default
settings.
To view the connectivity options:
1. On the Main screen, press F6 and select Connectivity Options.
OR
Select Tools menu > Connectivity Options.
2. Select one of the Connectivity Options tabs:
Icon Option Description

Report Delivery This tab lets you select the recipient of your
emailed and faxed results reports.
● Referring physician: Send reports to the
physician listed in the patient's Primary
information.
● Reading physician: Send all reports to the
physician listed in this field.
Fax The Fax option is available if you purchased the
TeleDensitometry kit. An analog phone line is
required.
This tab lets you change the default fax settings.
● Sender’s Name: Enter name.
● Contact Phone Number: Enter phone number.
● Receive Incoming Faxes: Lets you receive faxes
if there is a fax modem attached to the system.
● Invert Image: Select to invert the gray scale of
images in faxes.
Email The Email option is available if you purchased the
TeleDensitometry kit. If using Outlook, set up a
Personal Address Book to interface with enCORE.
This tab lets you change the default email settings.
● To: Default email recipient.
● Subject: Default subject line text.
● Add case information to Subject: Select to
automatically include the patient's name, scan
type, and name of the file you are emailing in
the Subject line.
● Message: Default message text.
● Invert Image: Select to invert the gray scale of
images in emails.
● Image Type: Select JPEG or PDF.
● Image Quality: Choose the quality level for
images included in emails. Quality affects the
size of the image.
● Disable Use of Personal Address Book: Disable
email address book.
Icon Option Description

DICOM The DICOM option is available if you purchased
the DICOM kit.
This tab lets you change default DICOM settings.
● DICOM reports can be sent in Image (CR),
Secondary Capture, Encapsulated PDF, or
Structured Report format.
● If you change the store folder location, be sure
to change the Report Folder Location setting
in the Lunar DICOM program.
● DICOM Worklist displays a list of patients who
are scheduled for DXA measurements. The list
is supplied by the hospital information system
(HIS). To use this feature, select Directory in
Worklist Mode.
HL7 The HL7 option is available if you purchased the
HL7 kit.
Do not change any of the HL7 default settings
without authorization from your network
administrator.
This tab lets you change the default HL7 settings.
● Worklist Mode displays a list of patients who
are scheduled for DXA measurements. The list
is supplied by the hospital information system
(HIS). To use this feature, select Directory In
Worklist Mode.
● Use the Reporting options to send HL7 reports
in text (ORU) or image (MDM) format.
Support This tab lists fax and email information for the
site’s service provider. The program uses this
information to email or fax QA reports to the
service provider if QA fails.
Error Log
If you encounter difficulties that prevent normal operation of the program, view the
Error Log for a list of errors that may be causing the problem.
To view the Error log, select Options (F6) from the Main screen and then select Error
Log, or select Tools menu > Error Log.
To export the Error Log, select Tools > Send Configuration and select Error Log.
The error log consists of two sections:
● Sessions: Lists the dates and times that the program was being used and the
number of errors that occurred during each session.
● Errors: Gives a description of each error that occurred during the selected session.
Click Troubleshoot to see a help topic about the selected error. Click Find Errors
to see similar errors in the list.
Reporting Errors to GE
If you cannot correct the error condition, go to Tools > Send Configuration and check
the Error log and Configuration files options. Email the files to GE Support or your
GE Distributor.
You can also print the error log by selecting Print Errors. Call your GE representative
and provide them with the error description as shown in the Errors section.
Security
11
Introduction
This section describes the security features, functionality and administrative
requirements of GE Healthcare enCORE software. It is provided to assist you in using
the system in a manner that protects patient privacy and security in your setting, and
to work in accordance with local and federal regulatory requirements.
This section also addresses expectations for the environment where the enCORE
software will be used, and contains information regarding security upgrade
procedures.
The healthcare provider is encouraged to use risk management procedures to assess
and prioritize security and privacy risks. Based on a risk assessment, the capabilities
of enCORE software can best be applied. The risk assessment should carefully balance
regulatory compliance, patient safety, as well as security. In cases where security
mitigation conflicts with patient safety, patient safety should be considered a higher
priority.
Security Features
The enCORE software incorporates a broad assortment of security features designed
to allow a complete and flexible approach to safe and secure implementation,
focusing on the principles of confidentiality, integrity, and availability. Information on
the capability and use of these features are detailed throughout this document.
Access Controls
Access control is the overall mechanism used to determine and enforce:
● Who has access
● How individuals gain access
● When access is permitted
● What information may be accessed
Access controls can have both physical and electronic aspects, and include
authentication and authorization process.
With Windows, you can set up security policies to control access to your enCORE
software workstation and patient files. A Windows user account defines the actions a
user can perform in Windows, such as:
● Who accesses your computer
● What resources users are authorized to use on your computer
Security
You can also set up Windows auditing so that a user’s or a group’s actions are
recorded in the Windows event log. Please see the Audit Controls (259) section for
more information on how to enable local security auditing.
Windows User Account Requirements

Each enCORE user must have a Windows user account that is assigned to one of the
following pre-defined Windows Groups:
● Users
● Administrators
An enCORE administrator must have a Windows user account that is assigned to a

Windows Group that has Windows administrator rights. An account with Windows
administrator rights is required to install the enCORE software and to configure the
enCORE security settings.
Application Security Settings

You can configure enCORE security settings so that advanced enCORE features, such
as the ability to create Composer reports, are available only to certain users. To enable
the security settings, complete the following tasks:
● Create specially-named Windows User Groups
● Add enCORE users to the Windows User Groups
● Configure Windows User account properties for electronic signatures (if
appropriate)
● Set up enCORE groups to have access to certain functionality based on user role
Once configured, when a user logs in to the Windows operating system and starts the
enCORE software, the functionality within the enCORE software is limited based on
the user’s assigned role
Create Windows User Groups

Creating Windows User Groups is an administrator task performed through the
Microsoft Management Console (MMC) with the Local Group Policy Editor. The Local
Group Policy Editor is a snap-in through which all the settings of Local Group Policy
objects can be managed.
1. Open the Local Group Policy Editor by clicking the Windows Start button and
typing Computer Management into the Search box. Select the Computer
Management program from the list of search results. In the left pane of the
Computer Management window, expand Local Users and Groups.
2. In the right pane, double-click the Groups folder.
3. Select Action > New Group.
4. Create one or more groups, adding the prefix “enCORE” to the group name.
Groups with this prefix will appear in the enCORE software when setting up the
security settings to limit enCORE functionality.
Example group names are:
● enCORETechnicians
● enCOREPhysicians
● enCOREAdministrators
Security
Add Users to Windows Groups

Note: Each User account to be added to an “enCORE” Windows Group must be a
member of one of the following pre-defined groups:
● Users
● Administrators
1. Open the Local Group Policy Editor by clicking the Windows Start button and
typing Computer Management into the Search box. Select the Computer
Management program from the list of search results. In the left pane of the
Computer Management window, expand Local Users and Groups.
2. In the right pane, double-click the Users folder.
3. Right-click the name of the User to be added and choose Properties.
4. In the Properties window, select the Member Of tab.
5. Click Add. The Select Groups window appears.
6. Enter the appropriate “enCORE” Group as the object name to select. For example,
enter enCOREPhysicians.
7. Click OK and verify the group is listed on the Member Of tab.
8. Click OK to close the Properties window and finish.
Configure User Accounts for Electronic Signatures

When the enCORE security settings are configured to allow a user to Digitally Sign
Reports, the name of the user as specified in the Windows User account will appear
on reports as the Reading Physician.
To configure a User account for the electronic signatures functionality:
● Specify the user’s name in his or her Windows User account. To do this, open
the Local Group Policy Editor, right-click the user, choose Properties, and enter
the user’s name in the “Full name” field.
● Add the User to the enCORE group that is configured to allow users to Digitally
Sign Reports.
Configure Application Functions Available to Groups

The following steps describe how to enable the enCORE software to limit functionality
based on role. An account with Windows administrator rights is required to configure
these security options.
1. Select Tools > User Options > Systems tab > Security Settings button. This
opens the Security Options window.
2. Select Limit Functionality based on user role. When selected, this option restricts
what enCORE functions a user can perform based on the group settings you
are about to configure.
3. Click Add Groups.
4. Select the group(s) for which you want to limit functionality. For example, select
“enCOREPhysicians” and click OK.
Security
5. With a group selected in the Configure Limited Functionality window, click Edit
Group Settings. This opens the Change Security Settings window for the selected
group.
6. Select the application functionality to which the selected group will have access.
For example, for the enCOREPhysicians group, choose Create Composer Reports.
Select one or more of the following options:
● Modify Configuration. Allows system configuration changes.
● Modify Style Sheets. Allows style sheet editing.
● Measure. Allows patient measurement.
● Analyze. Allows exam analysis adjustments.
● Create Composer Reports. Allows creation of Composer reports.
● Digitally Sign Reports. Automatically applies the user’s name to reports.
This option requires the user’s name to be specified in the Full name property
of his or her Windows User account.
7. Click OK and return to the Security Options window.
8. Click OK to close the Security Options window and finish.
Authentication
Authentication is the process of proving individual identity and is a key element in an
access control system.
User accounts with passwords can be set up to restrict access to patient health
information to only authorized users. The Windows operating system supports
advanced password controls. Passwords can be controlled based on age, pattern,
length, history, and dictionary.
A greater level of system security can be obtained by modifying the accounts and
passwords from their factory settings.
Password Management
Password use has some risks, as passwords may be forgotten, lost, guessed, or
“cracked” with various methods such as dictionary and brute-force attacks. To make
passwords safer, several rules can be applied to password creation.
Password Common Settings Comments
Attribute
Minimum 4 – 16 characters Shorter passwords are easy to remember, but
Length also easier to compromise. Longer passwords
are more secure, but more likely to be
forgotten or written down. Longer passwords
are more resistant to brute force attacks
Expiration 30 – 360 days, or Off Expiration dates force users to change
passwords on a regular basis. A rule of
thumb is to balance expiration with length,
so that passwords expire before they could
be cracked.
Security
Password Common Settings Comments

Attribute
Character Require mixed case This is a set of attributes that is used to
Composition letters, numbers, increase the number of possible password
and/or special combinations, thwarting dictionary attacks
characters. and mitigating brute force attacks. It also
makes passwords harder to guess.
Failed 5 - 15 attempts, or Locking a user account after a number
Attempt Off of failed login attempts is a very effective
Lockout countermeasure for password attacks. Some
systems allow temporary lockouts (typically
5-30 minutes) so that system administrator
intervention is not required to reactivate the
account.
Dictionary On, Off Checks passwords against a database, and
Check does not allow users to create passwords
which are common.
Password Off, Number of past Prohibits users from setting passwords they
Reuse passwords checked have used in the past, so that they don’t
circumvent the protection afforded by having
expiration dates. If used, depth of history
(number of past passwords to check) should
be specified.
Password On, Off Prevents users from making passwords that
Increment are not significantly different from a previous
password, such as password1, password2,
and password3 or trick, track, and truck in
succession.
An assessment of risk levels is important for setting attributes appropriately. There

is not a single “correct” combination of password attributes. Often, increasing the
security setting in one category allows relaxation in another to achieve the same level
of protection. Password strength rules should be carefully balanced to reduce the
likelihood that users will write down or forget their password.
Authorization
Authorization is the process of granting and revoking an individual’s rights to access
information, functionality, or services, and is another key element in an access
control system. Although primarily an administrative process that is driven by an
organization’s policies and procedures, enCORE software contains features that help
implement and enforce an organization’s method.
enCORE software can be run with a restricted user account. Restricted users are
unable to install programs or change operating system settings.
Audit Controls
The ability to record and examine system activity is crucial to a successful information
security program, as well as compliance with regulatory requirements in many
environments. This section covers security audit logs only. Clinical, diagnostic, and
service logs are covered elsewhere.
Security
Enable Local Security Auditing

1. Log on to Windows with an account that has Administrator rights.
2. Navigate to Start > Control Panel > Administrative Tools > Local Security Policy.
This starts the Local Security Settings snap-in in Microsoft Management Console
(MMC).
3. Navigate to Local Policies > Audit Policy.
4. In the right pane, double-click the policy you want to enable or disable. See the
table below for details.
5. Check the Success and/or Failure boxes as appropriate.
Relevant Local Audit Policies

Setting Description
Audit logon events Determines whether to audit each instance of a user logging
on to, logging off from, or making a network connection to
this computer.
Audit account Determines whether to audit each event of account
management management on a computer such as when a password is set
or changed.
Audit object access Determines whether to audit the event of a user accessing an
object (file, folder, registry key, printer, etc.) that has its own
system access control list (SACL) specified.
Audit system events Determines whether to audit when a user restarts or shuts
down the computer or when an event occurs that affects
either the system security or the security log.
Create an Audit Log of Patient File Access

1. In Windows Explorer, right-click the patient database directory and select
Properties.
2. On the Security tab, click Advanced.
3. On the Auditing tab, click Add.
4. Enter the Users or Groups you want to audit.
5. In the Auditing Entry dialog, check the Read Attributes and Write Attributes
boxes for both Successful and Failed.
6. In the Apply Onto list box, select Files Only.
7. Click OK in all dialogs.
Every time a patient file is accessed, an event is recorded in the Security Log
indicating the date, time, file, user account and computer used to access the file.
View the Security Log

1. In Windows, navigate to Start > Control Panel >Administrative Tools > Event
Viewer.
Security
2. In the left pane, select Security.

3. In the right pane, double-click a security event to view details.
Configure the Security Log

1. In Windows, navigate to Start > Control Panel >Administrative Tools > Event
Viewer.
2. In the left pane, right-click Security and click Properties.
3. Test and adjust the log size and Overwrite events setting to meet local security
needs.
Malicious Software Protection

The computing environment is increasingly hostile, and threats continue to grow
from malicious software, including computer viruses, worms, Trojan horses, denial
of service attacks, and other malware. Vigilant defense on many levels is required
to keep systems free from compromise by malicious software. Effective protection
requires cooperation and partnership between GE and our customers.
Customer Responsibilities
Customers are responsible for staying informed about vulnerability information and its
impact on GE Healthcare systems by visiting the GEHC Product Security website. Refer
to Using the GEHC Product Security Database (268). Customers are also responsible
for the installation of validated Microsoft security software patches.
1. Owners of enCORE-based systems are to apply the validated Microsoft security
patches appropriate for their version of the Windows operating system:
2. The patches are available for download from Microsoft’s website at
http://www.microsoft.com/technet/security/default.mspx
3. Select the Security Bulletins tab.
4. On the next page, select the link for the appropriate bulletin.
5. On the next page, choose the download link for the operating system that the
product uses.
6. On the next page, select the appropriate language option, and then click the
Download button.
7. When prompted for file download, save the patch file to your computer’s Desktop.
8. After the file download has completed, and run the patch to install it.
Product Features
Product features that contribute to malware defense include:
● Device design and configuration (hardening): System computers are shipped

with only the minimum services and protocols required to operate turned on. All
Security
unnecessary operating system services and protocols are turned off by default.
This helps to restrict unauthorized access.
● Security updates and patching processes: At the time of product release, any
critical operating system security patches are installed on the system. Additionally,
any new security patches are automatically loaded with every software update.
GE Healthcare releases security patch validation information through the GEHC
Product Security Website http://prodsecdb.gehealthcare.com and Technical
Support in a timely manner.
You need a GE Single Sign-On (SSO) to log in. If you do not

have a GE SSO, you may obtain one by clicking the Sign Up
Now link on the GE SSO Login page.
Unauthorized Network Access

Today, the delivery of healthcare to patients increasingly relies on modern information
technology (IT) to electronically collect, process, distribute, display, and store patient
data. Any computer connected to a network is vulnerable to network virus and/or
other malicious attacks. Owners and operators of any medical device that is
connected to a network are responsible for protecting their computers from these
malicious attacks.
Virus Protection Software with enCORE

You can protect your computers by following standard PC practices used for all
information technology. Anti-virus programs are an appropriate measure to assure
electronic media and files are virus free before being introduced to your network. The
latest validated operating system patches should also be installed.
Anti-virus programs should be installed and active on the enCORE computer operating
the bone densitometer. However, virus scanners have significant drawbacks including
the following:
● Do not initiate an anti-virus scan when operating the bone densitometer. Certain
files may be marked read-only.
● Anti-virus software may act inappropriately on false positives. Double check
quarantine status before taking any permanent action. Medical image files can
be damaged because the virus scanner attempts to fix what it falsely identified
as a virus.
● enCORE software may not operate properly if the virus scanner consumes too
much memory or system resources.
Security
Workstation Security
You can set up a screen saver with password protection to lock access to the system
after a select period of inactivity.
To protect against over-the-shoulder access while the system is unattended, it is
recommended that secure session locks be established on the system.
You can also set up user accounts to lock out the account after a predetermined
number of successive failed login attempts.
Data Protection
Data protection and privacy is often driven by administrative policies and procedures
of the customer. enCORE software contains functionality that may help implement
data protection initiatives.
Device-to-device authentication by AE Title and IP address is supported for DICOM
and HL7 services.
128-bit data encryption is supported over the Internet.
When GE personnel require exam files for the purpose of servicing a system, the
files are obtained using the HIPAA Secure Copy process described below. In addition,
GE follows a well-defined Data Retention Policy with respect to these exam files,
and when systems are retired due to replacement. Contact GE to obtain a copy of
this Data Retention Policy.
HIPAA Secure settings of enCORE
HIPAA Secure Filename, when enabled, ensures generation filenames of patient
exams without patient information. Encrypt Exam Files, when enabled, saves the
patient exam data in encrypted format.
1. Select Tools menu > User Options.
2. On the Systems tab, select Exam File Options.
3. HIPAA Secure Filename and Encrypt Exam Files settings are shown. They are
both enabled by default.
4. Click Cancel to exit.
HIPAA Secure View, when enabled, hides all patient information on all screens.
1. Select Tools menu > User Options.
2. On the Systems tab, select User Interface Options.
3. HIPAA Secure View settings are shown. It is disabled by default.
HIPAA Secure Copy, when enabled, allows bulk patient de-identification. All patient
identifying information (including name, ID, address, telephone number, and insurance
information) can be removed before exchanging patient databases or scan files.
When data is transferred to external media without using HIPAA Secure Copy, after the
media is no longer needed it should be disposed of securely and safely. Disposal of
sensitive items should be logged where necessary in order to maintain an audit trail.
1. Select Directory menu > Send Exam to (disk or email).
2. HIPAA Secure Copy (purge patient data) settings are shown. It is enabled by
default.
Security

HIPAA Secure Report, when enabled, hides patient identifying information (name, ID,
etc.) on any exam report.
1. Open any exam from any patient.
2. Select Report > Show Advance Features.
3. HIPAA Secure Report settings are shown. It is disabled by default.
It can be enabled by default, or on a report-by-report basis.
4. To enable by default, select Set As Default.
Security Operations
This section focuses on security operations, and contains information to guide in the
preparation of a secure environment for enCORE software.
Security operations are best implemented as part of an overall “defense in depth”
information assurance strategy used throughout an Information Technology system
that addresses personnel, physical security and technology. The layered approach
of defense in depth limits the risk that the failure of a single security safeguard will
allow compromise of the system.
Network Security
GE strongly recommends that medical devices be operated in a secure network
environment that is separate from an organization’s general purpose computing
network. There are many effective techniques for isolating medical devices on a
secure sub-network, including implementing firewall protection, demilitarized zones
(DMZs), Virtual Local Area Networks (VLANs), and network enclaves.
GE recommends verifying the following system configuration:
1. Disable TCP test services
2. Disable file and print sharing
3. Disable NetBIOS over TCP/IP (when available)
Business Continuity
Patient data archive and backup is supported to protect against hardware failures
and other disasters. Refer to Archive (217) and Restore Backup (218).
GE recommends the use of uninterruptible power supplies to reduce the risk of data
loss due to unexpected power outages to the enCORE system.
Media Access Control Points

Unsecured removable media and media access ports represent a risk of data loss and
theft. Restrict access to all archive media and computer access points to authorized
personnel only.
Portable media is a common archive option. Store media in a secure, locked location.
Secure access points such as USB ports through workstation security measures.
Security
Remote Service
Often the most efficient and cost effective manner for GE to provide service is to
remotely connect to the enCORE system. Every effort is made to ensure that this
connection is as secure as possible.
The enCORE software supports InSite remote connectivity. There is no remote
activation of the scanner at any time.
No connection to a customer’s system is possible unless the customer is at their
system and enables the InSite session to occur.
Security programs provided by the customer’s Internet service provider (ISP) or local
IT person may be used as long as a security scan is not activated when the enCORE
program is running. Close the enCORE software before running a security utility.
The enabling of remote access services poses unique security risks. Remote access
services, such as Microsoft Windows Remote Desktop, are not required for and are
not enabled by enCORE software operation. Remote access services are disabled
by default. Note that, although remote access is available through the use of the
InSite ExC Service Tool, these operations are performed outside of Microsoft Windows
Remote Desktop, through a secure connection. See the InSite ExC Service Tool
documentation for details.
InSite 2 Components
● Service Agent: The customer’s InSite 2 program interface is referred to as the
Service Agent. The customer’s computer acts as a local server and controls the
connection functions. The Service Agent’s role is to establish secure communication
to the GE Enterprise Server via an https connection on the Internet.
● Lunar System Service Tool: The Lunar System Service Tool, or Virtual Assistant,
controls the service connection.
● RCOC directory: The RCOC enables the remote desktop tunnel to share the
customer’s computer screen.
● File Transfer folders: These folders are located on the root drive of the customer’s
computer.
InSite ExC components

● Service Agent: The customer’s InSite ExC program interface is referred to as the
Service Agent. The customer’s computer acts as a local server and controls the
connection functions. The Service Agent’s role is to establish secure communication
to the GE Enterprise Server via an https connection on the Internet.
● Connect GE: Connect GE controls the service connection.
● Virtual Network Connection (VNC): The VNC enables the remote desktop tunnel to
share the customer’s computer screen.
● File Transfer folders: These folders are located on the root drive of the customer’s
computer.
● Common Service Desktop: The Common Service Desktop provides a standardized
frame for service activities.
Security
Network Interface Specifications and Risk

Management
The iDXA, Prodigy, and DPX series products are intended to be connected to a network
to support the following functionality:
● DICOM connectivity to other DICOM devices. enCORE’s use of DICOM does not
integrate DICOM data encryption or TCP/IP traffic-tampering controls.
● HL7 connectivity to other HL7 devices. enCORE’s use of HL7 does not integrate HL7
data encryption.
● Remote service diagnostics and configuration via InSite ExC.
IHE Integration Profiles

Several IHE integration profiles are supported. The following table lists the
implemented profiles and which actors are implemented for each profile.
Integration Profiles Actors
Scheduled Workflow (SWF) Acquisition Modality
Patient Information Reconciliation (PIR) Acquisition Modality
Evidence Documents (ED) Acquisition Modality
Access to Radiology Information (ARI) Image Display

Consistent Time (CT) Time Client
HL7 Message Types

Several HL7 message types are supported. The following table lists the implemented
interfaces and which message types are implemented for each interface.
Interfaces Message Types
Orders ORM, ADT, DFT, OMG
Results ORU, MDM
Network Interface Technical Specifications

Connection Name PC Motherboard NIC
Physical network connection type IEEE 802.3 10/100BASE-T Ethernet
Speeds and duplex modes supported 10Mbps half and full duplex
100Mbs half and full duplex
Auto-negotiate (default)
Default IP settings (from factory) DHCP (Prodigy & DPX)
IP Address – 192.168.0.199 (iDXA only)
Subnet Mask – 255.255.255.0 (iDXA only)
IP addressing IPv4
DHCP (default for Prodigy & DPX)
Static (default for iDXA)
Security
Connection Name PC NIC Card (iDXA only)

Physical network connection type IEEE 802.3 10/100BASE-T Ethernet
Speeds and duplex modes supported 10Mbps half and full duplex
100Mbs half and full duplex
Auto-negotiate (default)
Default IP settings (from factory) DHCP
IP addressing IPv4
DHCP (default)
Static
Network Information Flows

Flow Name DICOM Connectivity
Network connection on device PC NIC card (iDXA)
Motherboard NIC (Prodigy, DPX)
Usage type, function, purpose Connectivity to other DICOM devices
Optional/required Optional
Communication partners PACS, RIS
Middle layer protocols TCP
Application layer protocol and encoding DICOM
Ports 104 (default) for Q/R
2800 (default) for storage commitment
Traffic characterization and bandwidth On demand, local user initiates to query
requirements DICOM worklist from RIS, to send MPPS
messages during an exam, to transfer
reports to PACS, or to query/retrieve archived
images.
PACS sporadically initiates as required
for DICOM storage commitment
N-EVENT-REPORT messages.
Flow Name HL7 Connectivity

Network connection on device PC NIC card (iDXA)
Usage type, function, purpose Connectivity to other HL7 devices
Communication partners EMR, HIS
Application layer protocol and encoding HL7 2.x
Security
Flow Name HL7 Connectivity

Ports 3773 (default) receiving port
3774 (default) sending port
Traffic characterization and bandwidth EMR/HIS system sporadically initiates as
requirements required for HL7 order messages.
On demand, local user initiates to send result
messages to EMR/HIS.
Flow Name InSite ExC HTTPS tunnel

Network Connection on device PC NIC card (iDXA)
Usage type, function, purpose Device servicing by GE Remote Service
Communication partner InSite ExC server
Device/IP address/network https://us0-rd.service.gehealthcare.com
TLS 1.2 (SSL 3.3)
Application layer protocol and encoding See Webmin Service HTTPS
Ports 443
Traffic characterization and bandwidth User initiates transport session (i.e., tunnel
requirements set-up) at the device to enable remote
service access.
Required Characteristics
The network must meet the specific requirements above for all traffic flows associated
with the subset of features, use cases and workflows required by the responsible
organization’s users.
Potential Risks to Safety, Effectiveness or Security

● Delayed or impaired access to images, exam information or patient data.
● Permanent loss or corruption of images, exam information or patient data.
The responsible organization should identify, analyze, evaluate and control risks on
an ongoing basis.
Using the GEHC Product Security Database

The GE Healthcare Product Security Database (PSD) is a web tool that offers customers
access to up-to-date information regarding the security of GE Healthcare products.
The PSD helps you determine which (Microsoft) security patches are approved for
installation on your GE system.
To log in and access the PSD, use this link:
http://prodsecdb.gehealthcare.com
Security
You need a GE Single Sign-On (SSO) to log in. If you do not

have a GE SSO, you may obtain one by clicking the Sign Up
Now link on the GE SSO Login page.
Refer to the PSD Getting Started or Help option for instructions in:
● Setting up your profile
● Retrieving the Product Vulnerability Table
● Retrieving a current Manufacturer Disclosure statement for Medical Device Security
(MDS2)
Security
Specifications
A
Systems Specifications
Lunar iDXA Series
Focal spot to detector distance (cm) 71.5
Focal spot to pad surface distance (cm) 24.5
Focal spot to AP Spine plane distance (cm) 34.0
Focal spot to table top distance (cm) 22
Focal spot to source collimator distance (cm) 19
Prodigy Series
Focal spot to detector distance (cm) 67
Focal spot to table top distance (cm) 22.3
Focal spot to source collimator distance (cm) 19
DPX NT/Pro/MD+
Focal spot to pad surface distance (cm) 15
Focal spot to source collimator distance (cm) 7.25
DPX Duo/Bravo
Specifications
Focal spot to source collimator distance (cm) 7.25
Physical Specifications
Lunar iDXA Series
Component Version Specifications
iDXA Scanner Full Size Table Dimensions: 287 cm x 131 cm x 125 cm (L x
table W x H)
Weight: approximately 360 kg
Maximum patient weight supported: 204
kg (450 lb)
Prodigy Series
Prodigy Advance, Full Size Table Dimensions: 262.3 cm x 109.3 cm x 128.3 cm
Prodigy Primo, (L x W x H)
Prodigy Forma Weight: approximately 272.16 kg
Scanner table*
Maximum patient weight supported: 159 kg
(350 lb)
Compact Table Dimensions: 201 cm x 109.3 cm x 128.3 cm (L
x W x H)
(350 lb)
Prodigy Primo, Full Size Table Dimensions: 262.3 cm x 109.3 cm x 128.3 cm
Prodigy, Prodigy (L x W x H)
Pro Scanner table* Weight: approximately 272.16 kg
(350 lb)
Compact Table Dimensions: 201 cm x 109.3 cm x 128.3 cm (L
x W x H)
(350 lb)
*Depth is measured from the front edge of the scanner table to the back edge of the
scanner arm. Height is measured from the top of the scanner arm to the bottom of
the scanner arm.
Specifications
DPX-NT/Pro/MD+
DPX NT/Pro/MD+ Full Size Table Dimensions: 242 cm x 103 cm x 128 cm (L x W
Scanner table* x H)
(300 lb)
Compact Table Dimensions: 181 cm x 103 cm x 128 cm (L x W
x H)
(300 lb)
*Depth is measured from the front edge of the scanner table to the back edge of the
scanner arm. Height is measured from the top of the scanner arm to the bottom of
the scanner arm.
DPX-Duo
DPX Duo Dimensions: 186 cm x 86 cm x 147 cm (L x
W x H)
(350 lb):
DPX-Bravo
DPX Bravo Dimensions: 186 cm x 86 cm x 130 cm (L x
W x H)
(350 lb)
Console table 78.5 cm x 63.3 cm x 48.1 cm
(optional)
Operational Environment Specifications

Adhere to these specifications during scanner operation.
Ambient Space (Interior Subcomponents)

For scanner operation and servicing, do not block the area around the scanner table.
Make sure there is a minimum clearance of 30 cm (24 cm for iDXA) at the head and
foot ends of the scanner table, at least 15 cm for the arm side, and 45 cm for the
operator side.
Specifications
Ambient Space (Ventilation)

Do not block the cooling vents on the computer and scanner table. Make sure there
is at least 15 cm between the console table and the wall for cable clearance and
computer plugs.
Dust, Fumes, and Debris

Install the system in a clean, ventilated area. Dust and other airborne debris can
cause the drive heads and other sensitive mechanical components to malfunction. Do
not smoke in the scanner room.
Humidity
Make sure the humidity for the scanner area is 20%-80%, non-condensing.
Power Consumption
For all scanner types, a dedicated 20A 100-127 VAC ±10% or 10A 200-240 VAC
±10% circuit (single duplex outlet) with isolated ground (THD<5%) is recommended.
The outlet should be located behind the host PC. See Declarations of Immunity and
Emissions table (321) for power quality guidance.
● The iDXA scanner draws approximately 40 watts when idle and approximately 525
watts during a patient scan (100kV / 2.5mA).
● The Prodigy and Prodigy Advance scanners draw approximately 40 watts when
idle and approximately 450 watts during a patient scan (76kV / 3mA).
● The Lunar DPX NT/Pro/MD+ scanners draw approximately 25 watts when idle and
approximately 250 watts during a patient scan (76 kV / 1.5mA).
● The Lunar DPX Duo and DPX Bravo scanners draw approximately 25 watts when
idle and approximately 250 watts during a patient scan (76kV / 1.5mA).
● The host PC (typical PC with a 17" monitor) draws approximately 110 watts when
powered on.
Specifications
Distortion
Sinusoidal waveform, less than 5% THD.
Heat Output
● The iDXA scanner outputs approximately 150 BTU per hour when idle and 1800
BTU per hour when actively scanning.
● The Prodigy and Prodigy Advance scanners output 150 BTU per hour when idle
and 1500 BTU per hour when actively scanning.
● The DPX NT/Pro/MD+/Duo/Bravo scanners output 90 BTU per hour when idle and
approximately 900 BTU per hour when actively scanning.
● The host PC (typical PC with 17" monitor) outputs approximately 400 BTU per hour
when powered on.
Static Electricity
Install and operate the system in a static-free area. Adhere to minimum humidity
requirements to prevent malfunctions caused by static electricity.
Shock and Vibration

Make sure the scanner table does not receive shock greater than 1G for more than
1 millisecond. Make sure the scanner table does not receive vibrations greater than
0.25 G at 1-100 Hz.
Temperature
Make sure the temperature during system operation is 65°F-81°F (18°C-27°C).
If the scanner is turned off for more than an hour, or if there is

a power failure, you must turn the system on and let it warm
for one hour. After one hour, complete a Quality Assurance
(59) procedure.
Specifications
Elevation
Lunar scanners are not for use above 3000 m.
Storage and Transport Environment

Specifications
Adhere to these specifications for scanner storage and transportation.
Humidity
0% to 95% non-condensing.
Atmospheric pressure
500 to 1060 hPa.
Temperature
-30° to 65° C.
Space Requirements
For safety reasons, the computer and all peripherals must be in the same room
with the scanner. Consult local regulations on radiation safety. Scanners should be
separated from MR equipment so the field is <1 Gauss.
Lunar iDXA Series Full-Size Table

Standard room configuration: The computer and peripherals must be located more
than 1.5 m or 1.83 m (USA and Canada) from the scanner. Recommended room
dimensions are: 4.0 m x 3.35 m (13.2 ft x 11 ft).
Specifications
iDXA full size table, standard room configuration
Small room configuration: Room dimensions must be at least 3.2 m x 3.35 m (10.5
ft x 11 ft) if the computer and peripherals are powered by an isolation transformer.
Equipment powered by an isolation transformer can be located anywhere in the
room with the scanner.
iDXA full size table, small room configuration
Specifications
Prodigy/Prodigy Primo/Prodigy Advance/Forma/Pro

Full-Size Table
dimensions are: 3.7 m x 3.7 m (12 ft x 12 ft).
Small room configuration: Room dimensions must be at least 3.0 m x 2.4 m (9.8 ft
x 7.9 ft) if the computer and peripherals are powered by an isolation transformer.
Prodigy/Primo/Advance/Pro Compact Table

Standard room configuration: The computer and all peripherals must be located
more than 1.5 m or 1.83 m (U.S.A and Canada) from the scanner. Recommended room
dimensions are 2.3 meters x 3.7 meters (7.5 feet x 12 feet).
Small room configuration: Room dimensions must be at least 2.3 m x 2.4 m (7.5 feet
x 8 feet) if the computer and peripherals are powered by an isolation transformer.
DPX NT/Pro/MD+ Full-Size Table

dimensions are: 3.7 m x 3.7 m (12 ft x 12 ft).
Small room configuration: Room dimensions must be at least 3.0 m x 2.4 m (9.8 ft
x 7.9 ft) if the computer and peripherals are powered by an isolation transformer.
DPX-Pro/NT/MD+ Compact Table, and DPX Bravo

Small room configuration: Room dimensions must be at least 2.3 m x 2.4 m (7.5 feet
DPX Duo
Small room configuration: Room dimensions must be at least 2.4 m x 2.8 m (8 feet
Specifications
Leakage Current
Computer and peripherals with isolation transformer: <100 microamperes.
Scanner table alone: <500 microamperes.
Input Power
Lunar iDXA Series

The scanner has rated input of 100-127 or 200-240 VAC, 50-60 Hz, 750VA. Voltage
may fluctuate ±10% from the rated input without a loss of scanner performance.
The input power must meet IEEE 519-1992 for power quality and total harmonic
distortion (THD <5%).
Prodigy Primo, Prodigy Forma, Prodigy Advance, Prodigy

systems DF±13000 and higher
The scanner has a rated input of 100-240 VAC (100-120 for US and Canada). Voltage
DPX Duo, DPX Bravo

DPX NT/Pro/MD+ systems 72000 and higher or 90000 and

higher
Specifications
Uninterruptible Power Supply (UPS)

If scanner power is provided by a UPS, the UPS must meet the following minimum
requirements:
Prodigy and DPX: 50/60Hz, 1000VA
iDXA: 50/60Hz, 1400VA, transient load capability of 18A for 300ms
Voltage and frequency shall be appropriate for country of installation. UPS must be
redundantly grounded to the wall outlet.
If the UPS is provided by GE Healthcare, it will meet all of the requirements above.
Fuse Capability
DPX Series: 3.15 A.
Prodigy Series: 3.15 A.
Lunar iDXA Series: No serviceable fuse.
Collimator Specifications
Lunar iDXA Series
Operation Voltage Power (W) Input Power
(VDC)
10 2.8 Model: GEBEL2374276
Input Voltage: 100-127 VAC; 200-240 VAC,
50/60 Hz; 750VA
Output Voltage: 10VDC @ 0.28A
Prodigy Series
(VDC)
12 4 Model: GLM75P
Input Voltage: 100-240VAC; 50/60 Hz; 3.1 A
Output Voltage:24vDC @4A; 12VDC @ 2.5A,
-12VDC@1A; 5V@8A
Specifications
DPX Series
(VDC)
12 3.5 Model: GLM75P
Input Voltage: 100-240VAC; 50/60 Hz; 3.1 A
Output Voltage:24vDC @4A; 12VDC @ 2.5A,
-12VDC@1A; 5V@8A
X-Ray Generator Technical Specifications

Lunar iDXA Series
Classification Class 1 Equipment
Degree of protection against Type B Equipment

electrical shock
Protection against ingress of Ordinary medical

liquids electrical equipment
Connection to supply mains Medical grade power

cord and isolation
transformer
Mode of operation Continuous
Rated mains voltage 85-144 VAC
Number of phases in mains 1
Mains frequency 45 - 66 Hz
Required over-current releases 15 Amp dedicated mains

service (for iDXA system)
Allowable tube head assemblies PN 40782 - iDXA X-Ray

Tube Head Assembly
Manufacturer GE Medical Systems
Model 40782
Specifications
Original language of English

accompanying documents
Maximum continuous kV, mA at 100kV, 2.5mA for 30m

nominal rated kV
Maximum intermittent kV, mA at 100kV, 2.5mA for 22.5m

nominal rated kV
Maximum continuous kV, mA at 100kV, 2.5mA

maximum mA
Maximum intermittent kV, mA at 100kV, 2.5mA

maximum mA
Continuous kV, mA for maximum 100kV, 2.5mA

electric output power
Intermittent kV, mA for 100kV, 2.5mA

maximum electric output
power
Nominal electric power 0.25kW, 100kV, 2.5mA
Lowest current time product 0.38mAs

Parameters: 100kV,
0.19mA, 2 seconds
Nominal shortest irradiation 2 seconds

times
X-Ray Tube Assembly Reference Line normal to X-Ray

Axis Tube Head Assembly
x-ray port, centered on
x-ray port as shown in
reference axis figure
X-Ray Tube Head Assembly Line intersecting

Longitudinal Axis and normal to both
Reference Axis and
X-Ray Tube Longitudinal
Axis, as shown in
reference axis figure
Specifications
Reference loading conditions 100kV, 2.5mA
Maximum heat content 1853kJ
Maximum continuous heat Dissipates 150W max.

dissipation into surrounding air
through forced air
convection
Leakage radiation load 100kV, 2.5mA

conditions
Focal spot to Image Receptor 715mm fixed

distance
Quality Equivalent Filtration of 0.5 mm Al ≤ Filtration ≤

patient support table 1.2 mm Al
Attenuation equivalence of < 0.3mm Al

material between patient and
image receptor
Permanent Filtration 4.3 mm Al/100kV
Maximum overall Dimensions 265L x 380W x 325H mm

(mm)
Mass < 32 kg ± 0.3 kg
kV Accuracy ±5% maximum
mA Accuracy ±20% maximum
Radiation output reproducibility 5% CV maximum
Specifications
Prodigy Series
Classification Class I Equipment
Degree of protection against Type B equipment

electrical shock

Connection to supply mains Power supply cord
Maximum X-ray tube voltage 76 kV
Maximum X-ray tube current 3 mA
Mains frequency 50/60 Hertz
Required over-current releases 15 Amp dedicated

service
Heat dissipative components X-ray tube dissipates

243W max. into
surrounding air through
forced air convection
Flow rate: 36 m3/h
(approx.)
Temp. rise of air stream
25° C (approx.)
Allowable high voltage supplies Spellman

SBD40PN280X2890
or SBD40PN280X4445 or
Bertan 2907
Specifications
Allowable tube head assemblies GE model 8743 or 45645

or equivalent

Maximum continuous kV, mA at 76 kV, 3 mA for 15m

nominal rated kV
Maximum intermittent kV, mA at 76 kV, 3 mA for 15m

nominal rated kV
Maximum continuous kV, mA at 76 kV, 3 mA

maximum mA
Maximum intermittent kV, mA at 76 kV, 3 mA

maximum mA
Continuous kV, mA for maximum 76 kV, 3 mA

Intermittent kV, mA for 76 kV, 3 mA

maximum electric output
power
Nominal electric power 0.243 kW
Lowest current time product 0.20 mAs

Parameters: 76 kV, 0.10
mA, 2 seconds

times
Method of x-ray tube voltage Voltage divider in high

measurement voltage power supply
Method of x-ray tube current Shunt resistor in high

measurement voltage supply return
line
Specifications
X-ray tube assembly reference Line normal to tube port,

axis centered on tube port as
shown in reference axis
figure
Reference loading conditions 8.21 x 105 Joules, 3 mA,

76 kV for 1 hour
Focal spot to Image Receptor 67 cm

distance


image receptor
DPX Series
Classification Class I Equipment
Degree of protection against Type B equipment

electrical shock

Connection to supply mains Power supply cord
Maximum X-ray tube voltage 76 kV
Specifications
Maximum X-ray tube current 1.5 mA
Mains frequency 50/60 Hertz
Required over-current releases 15 Amp dedicated

service
Heat dissipative components X-ray tube dissipates

243W max. into
surrounding air through
forced air convection
Flow rate: 36 m3/h
(approx.)
Temp. rise of air stream
25° C (approx.)
Allowable high voltage supplies Spellman

SBD40PN280X2890
or SBD40PN280X4445
or Bertan 2907
Allowable tube head assemblies GE model 8548 or 45649

or equivalent

Maximum continuous kV, mA at 76 kV, 1.5 mA for 30m

nominal rated kV
Maximum intermittent kV, mA at 76 kV, 1.5 mA for 30m

nominal rated kV
Maximum continuous kV, mA at 76 kV, 1.5 mA

maximum mA
Specifications
Maximum intermittent kV, mA at 76 kV, 1.5 mA

maximum mA
Continuous kV, mA for maximum 76 kV, 1.5 mA

Intermittent kV, mA for maximum 76 kV, 1.5 mA

Nominal electric power 0.129 kW
Lowest current time product Parameters: 76 kV, 0.10

0.20 mAs mA, 2 seconds

times
Method of x-ray tube voltage Voltage divider in high

measurement voltage power supply
Method of x-ray tube current Shunt resistor in high

measurement voltage supply return
line
X-ray tube assembly reference Line normal to tube port,

axis centered on tube port as
shown in reference axis
figure
Reference loading conditions 8.21 x 105 Joules, 1.5

mA, 76 kV for 1 hour
Focal spot to Image Receptor 58 cm

distance


image receptor
Specifications
X-Ray Tube Head Assembly

Reference Axis and Target Angles for Tube Head Assembly –
Lunar iDXA Series
Lunar iDXA Series Insert Specifications

Manufacturer Lohmann X-ray GmbH
Model 110/3 EFK
Nominal x-ray tube voltage 100 kV
Nominal anode input power 250 W
Maximum anode heat content 50 kJ
Anode target material (W) Tungsten
Target angle 10°
Nominal focal spot values 0,5 IEC 60336
Tolerance between Focal spot 1 mm
and Reference Axis
Inherent filtration 0.55 mm of Aluminum
equivalent
Specifications
Single Load Rating 100 kV, 2.5 mA

Serial Load Rating 100 kV, 2.5 mA for up to 30
minutes
Reference Axis and Target Angles for Tube Head Assembly –

Prodigy and DPX Series
X-Ray Tube Technical Information

GE X-ray Tube Insert (DPX NT/Pro/MD, DPX Duo, DPX Bravo, Prodigy Series)
Protection against electric shock Class I, Type B
Tolerance between Focal spot and Reference 2mm

Axis
Maximum anode heat content 18300 Joules
Specifications
Anode heating and cooling curves Refer to Prodigy Series, DPX NT/Pro/MD+/
Bravo/Duo Anode heating/cooling curves
(293)
Reference axis See reference axis figure
Nominal focal spot value 0,5 IEC 60336
Maximum useful voltage 88 kVp
Maximum filament current 2.2 A
Anode target material (W) Tungsten
Target angle 12°
GE (8743 and 45645) X-ray Tube Assembly (Prodigy Series)
Permanent Filtration 8743: 2,9 mm Al/76 kV (2,9 mm Al/70 kV)

45645: 3,3 mm Al/76 kV
IEC 60522
Filament characteristics Refer to Prodigy Series, DPX NT/Pro/MD+/

Bravo/Duo Filament emission characteristics
(295)
Nominal x-ray tube voltage 76 kV - Anode to Cathode

38 kV - Anode to Earth
38 kV - Cathode to Earth
Single load rating 228 W (3 mA, 76 kV) for up to 7.5 min
Serial load rating 228 W (3 mA, 76 kV) for up to 7.5 min.
Maximum x-ray tube assembly heat content 260 kJoules
Specifications
X-ray tube assembly heating and cooling Refer to Prodigy Series, DPX NT/Pro/MD+/
curves Bravo/Duo X-Ray Tube Assembly Heating
and Cooling Curves (296)
Maximum continuous heat dissipation 243 Watts (3mA x 76kV + 15W filament)
Maximum symmetrical radiation field 3.4 mm/19.5 mm at a distance from the focal
spot of 223 mm
Dimensions (L x W x H) 19.6 cm x 13.5 cm x 25.2 cm
Weight 8.6 kg
High Voltage cable connection LU41395, LU41396
GE (8548 and 45649) X-ray Tube Assembly (DPX Series)
Permanent Filtration 8548: 3,0 mm Al/76 kV (3,0 mm Al/70 kV)

45649: 3,3 mm Al/76 kV
IEC 60522
Filament characteristics Refer to Prodigy Series, DPX NT/Pro/MD+/

Bravo/Duo Filament emission characteristics
(295)
Nominal x-ray tube voltage 76 kV - Anode to Cathode

38 kV - Anode to Earth
38 kV - Cathode to Earth
Single load rating 114 W (1.5 mA, 76 kV) for up to 30 min
Serial load rating 114 W (1.5 mA, 76 kV) for up to 30 min.

with 5 min. cool-down time between
measurements
Maximum x-ray tube assembly heat content 260 kJoules
Specifications
X-ray tube assembly heating and cooling Refer to Prodigy Series, DPX NT/Pro/MD+/
curves Bravo/Duo X-Ray Tube Assembly Heating
and Cooling Curves (296)
Maximum continuous heat dissipation 129 Watts (1.5mA x 76kV + 15W filament)
Maximum symmetrical radiation field Diameter = 6.3 mm
Dimensions (L x W x H) 19.6 cm x 13.5 cm x 25.2 cm
Weight 8.6 kg
High Voltage cable connection LU41395, LU41396
Anode Heating/Cooling Curves

Lunar iDXA series
Specifications
DPX series/Prodigy series
Specifications
Filament Emission Characteristics

Lunar iDXA series
DPX series/Prodigy series (45645 and 45649)
Specifications
DPX series/Prodigy series (8743 and 8548)
X-Ray Tube Assembly Heating/Cooling Curves

If the x-ray tube maximum temperature is exceeded, the scan
will automatically abort with an error message. Please allow
the tube to cool down before attempting another scan.
Lunar iDXA Series X-Ray Tube Assembly Heating Curve
Specifications
Lunar iDXA Series X-Ray Tube Assembly Cooling Curve
Total energy input with cooling; actual heat content is lower.

Energy content values shown are taken from heating curve and represent actual
stored energy content which is lower.
DPX and Prodigy series
Maximum Scan Area (Long X Transverse)

Lunar iDXA Series
● AP Spine measurements: 42.7 cm x 22 cm
● Femur measurements: 20.5 cm x 20 cm (53.7 x 20 cm with AFF feature)
● Orthopedic Hip measurements: 45.8 cm x 20 cm
● Total Body measurements: 196.8 cm x 66 cm measurement field
● Forearm measurements: 42.7 cm x 10 cm
Specifications
● Lateral Spine measurements: 58.5 cm x 22 cm

● Lateral Spine Geo measurements: 69.5 cm x 22 cm
Prodigy Series
● AP Spine measurements: 42 cm x 22 cm
● Femur measurements: 20.2 cm x 20 cm (53.8 x 20 cm with AFF feature)
● Orthopedic Hip measurements: 45.4 cm x 20 cm
● Total Body measurements (full-size tables only): 197.7 cm x 60 cm measurement
field
● Forearm measurements: 42 cm x 10 cm
● Lateral Spine measurements: 58.8 cm x 22 cm
DPX NT/Pro/MD+
● Femur measurements: 21 cm x 20 cm
● Orthopedic Hip measurements: 46 cm x 20 cm
● Total Body measurements (full-size tables only): 195 cm x 60 cm measurement field
● Lateral Spine measurements: 59 cm x 22 cm
DPX Duo/Bravo
● Femur measurements: 21 cm x 20 cm
● Orthopedic Hip measurements: 46 cm x 20 cm
Scatter Radiation Diagrams

Isodose Diagram: Lunar iDXA Series Full Size Table
The following show isodose diagrams of iDXA Full Size Table scanner scatter radiation.
The measurements conformed to the IEC 60601-1-3 standard and were taken with a
Victoreen 6000-532 400cc Ion Chamber Paddle Probe. The beam was attenuated with
a water target having dimensions of 25x25x15 cm and container walls equivalent to
less than 1 cm of polymethyl-methacrylate (PMMA), otherwise known as Lucite. Each
measurement consisted of a static exposure at the maximum X-ray tube current
and voltage of 2.5mA and 100kV.
Specifications
Isodose diagram: Longitudinal, Lunar iDXA Series
Isodose diagram: Transverse, Lunar iDXA Series
Specifications
Isodose Diagram: Prodigy, Prodigy Advance, Prodigy Primo,

Prodigy Forma, Prodigy Pro Full-Size Table
The following display isodose diagrams of the Prodigy series full size scanner scatter
radiation. The measurements were taken with a Victoreen 470A. The beam was
attenuated through a 20 cm water phantom.
Isodose diagram: Foot-end view, Prodigy full-size table
Specifications
Isodose diagram: Front view, Prodigy full-size table
Isodose Diagram: Prodigy, Prodigy Advance, Prodigy Primo,

Prodigy Pro Compact Table
The following display isodose diagrams of the Prodigy series compact scanner scatter
radiation. The measurements were taken with a Victoreen 470A. The beam was
attenuated through a 20 cm water phantom.
Specifications
Isodose diagram: Foot-end view, Prodigy compact table
Specifications
Isodose diagram: Front view, Prodigy compact table
Isodose Diagram: DPX NT/Pro/MD+ Full Size Table

The following display isodose diagrams of scatter radiation for the full-size DPX-NT/Pro
and MD+ scanners. The measurements were taken with a Victoreen 470A. The beam
was attenuated through a 20 cm water phantom.
Specifications
Isodose diagram: DPX NT/Pro/MD+, full-size table
Specifications
Isodose Diagram: DPX-Pro/NT/MD+ Compact Table, DPX

Duo and DPX Bravo
The following display isodose diagrams of scatter radiation for the compact
DPX-NT/Pro and MD+ scanners, the DPX Duo and DPX Bravo scanners. The
measurements were taken with a Victoreen 470A. The beam was attenuated through
a 20 cm water phantom.
Specifications
Isodose diagram: DPX-Pro/NT/MD+ compact table, Duo/Bravo
Specifications
Current and Typical Dose Tables
Lunar iDXA Series

Lunar iDXA Series current and typical dose
Typical
Measurement Estimated Skin
Current Area (L cm x Irradiation Entrance Dose
Site ModeA (mA)B W cm)D,E Time (sec)C,D,E (μGy)F,G
AP Spine Thick 2.500 15.8 x 12.0 62 329
AP Spine Standard 2.500 15.8 x 12.0 30 146
AP Spine Thin 0.625 15.8 x 12.0 30 37
AP Spine QuickView 2.500 15.8 x 12.0 15 47
Femur Thick 2.500 15.8 x 12.0 62 329
Femur Standard 2.500 15.8 x 12.0 30 146
Femur Thin 0.625 15.8 x 12.0 30 37
Femur QuickView 2.500 15.8 x 12.0 15 47
Femur Thick - AFFI 2.500 25.3 x 12.0 99 329
2.500 19.0 x 12.0 74 329
Femur Standard - 1.250 25.3 x 12.0 56 75

AFFI
2.500 19.0 x 12.0 36 146
Specifications
Typical
Femur Thin - AFFI 0.625 25.3 x 12.0 56 38
0.625 19.0 x 12.0 36 37
DualFemur Thick 2.500 2 x 15.8 x 12.0 124 329
DualFemur Standard 2.500 2 x 15.8 x 12.0 61 146
DualFemur Thin 0.625 2 x 15.8 x 12.0 61 37
DualFemur QuickView 2.500 2 x 15.8 x 12.0 30 47
DualFemur Thick - AFFI 2.500 2 x 25.3 x 12.0 198 329
2.500 2 x 19.0 x 12.0 148 329
DualFemur Standard - 1.250 2 x 25.3 x 12.0 112 75

AFFI
2.500 2 x 19.0 x 12.0 72 146
DualFemur Thin - AFFI 0.625 2 x 25.3 x 12.0 112 38
0.625 2 x 19.0 x 12.0 72 37
APVAH Thick 2.500 37.9 x 15.0 89 146
APVAH Standard 2.500 37.9 x 15.0 89 146
APVAH Thin 0.625 37.9 x 15.0 89 37
Specifications
Typical
Forearm Standard 0.188 14.2 x 10.0 24 10
Hand Standard 0.188 25.3 x 18.0 69 10
Total Body Thick 0.188 153.1 x 66 619 6
Total Body Standard 0.188 153.1 x 66 339 3
Total Body Thin 0.188 153.1 x 66 339 3
Total Body Small 0.188 101.1 x 40 577 11
LVAH Standard 2.500 37.9 x 15.0 183 329
LVAH Thin 0.625 37.9 x 15.0 183 82
Lateral Spine Standard 2.500 15.8 x 12.0 62 329
Orthopedic Thick 2.500 23.7 x 15.0 115 329

Hip
Orthopedic Standard 2.500 23.7 x 15.0 55 146

Hip
Orthopedic Thin 0.625 23.7 x 15.0 55 37

Hip
Specifications
Typical

Knee
Small Animal Small 0.188 75.8 x 25.0 279 10
Small Animal Medium 0.188 101.1 x 40.0 577 10
Small Animal Large 0.188 184.7 x 65.3 406 3
A All modes are 100kV, ±5%.

B Tube current is ±20%.
C Imaging time measured from shutter open to shutter close, 90% to 100% of
indicated value.
D Sizes of measurement areas and irradiation times will be less than those listed above
if you use the SmartScan feature.
EMeasurement lengths and times are dependent on patient height and product
version.
FDose measurements are constrained by Daily QA limits. For example, the maximum
spine (standard mode) range is 60 to 249 µGy. To simulate an average patient, 15 cm
of acrylic is used for back-scatter material.
G Irradiation times and dose values do not consider a "sweep retry" feature which can
double the dose for a single transverse sweep within an entire scan. If a retry occurs a
slight increase in irradiation time and skin entrance dose would be expected. The retry
feature reduces need to rescan entire patient.
H Activation of the spine geometry application permits a maximum scan length up to
69.5 cm.
IFemur AFF modes consist of two exposures, one for the distal and the other for the
proximal femur, which use different exposure factors.
Specifications
Prodigy series
Prodigy, Prodigy Advance, Prodigy Pro current and typical dose
Typical
Measurement Estimated
Current Area (L cm x Irradiation Skin Entrance
Site Mode1 (mA)2 W cm)4,5 Time (sec)3,4,5 Dose (μGy)6,7
AP Spine Thick 3.000 15.1 x 12.1 56 83
AP Spine Thin 0.750 15.1 x 12.1 28 9
AP Spine QuickView 3.000 15.1 x 12.1 14 12
Femur Detail 3.000 15.1 x 12.1 56 83
Femur Thick 3.000 15.1 x 12.1 56 83
Femur Standard 3.000 15.1 x 12.1 28 37
Femur Thin 0.750 15.1 x 12.1 28 9
Femur QuickView 3.000 15.1 x 12.1 14 12
Femur Thick - AFF8 3.000 25.2 x 12.1 94 83
3.000 18.5 x 12.1 69 83
Femur Standard - 1.500 25.2 x 12.1 46 18.5

AFF8
3.000 18.5 x 12.1 34 37
Specifications
Typical
Femur Thin - AFF8 0.750 25.2 x 12.1 46 9
0.750 18.5 x 12.1 34 9
DualFemur Thick/ 3.000 2 x 15.1 x 12.1 112 83

Detail
DualFemur QuickView 3.000 2 x 15.1 x 12.1 28 12
DualFemur Thick - AFF8 3.000 2 x 25.2 x 12.1 188 83
3.000 2 x 18.5 x 12.1 138 83
DualFemur Standard - 1.500 2 x 25.2 x 12.1 92 18.5

AFF8
3.000 2 x 18.5 x 12.1 68 37
DualFemur Thin - AFF8 0.750 2 x 25.2 x 12.1 92 9
0.750 2 x 18.5 x 12.1 68 9
Hand Standard 0.150 23.5 x 18.0 61 2
Specifications
Typical
Total Body Thick 0.150 153.5 x 60 532 0.8
Total Body Standard 0.150 153.5 x 60 295 0.4
Total Body Thin 0.150 153.5 x 60 295 0.4
Total Body Small 0.150 100.9 x 40.1 540 1.8
Lateral BMD Standard 3.000 15.1 x 12 56 83
LVA Standard 3.000 38.7 x 15.0 175 83
APVA Thick 3.000 38.7 x 15 85 37
APVA Standard 3.000 38.7 x 15 85 37
APVA Thin 0.750 38.7 x 15 85 9
Orthopedic Thick 3.000 20.2 x 15 91 83

Hip
Orthopedic Standard 3.000 20.2 x 15 44 37

Hip
Orthopedic Thin 0.750 20.2 x 15 44 9

Hip

Knee
Specifications
Typical
Small Animal Small 0.15 75.7 x 25.0 261 1.8
Small Animal Medium 0.15 100.9 x 40.1 540 1.8
Small Animal Large 0.15 195.0 x 59.6 373 0.4
Prodigy Primo/Prodigy Forma current and typical dose
Typical Mea-
surement Irradiation Estimated
Current Area (L cm times Skin Entrance
Site Mode1 (mA)2 x W cm)4,5 (sec)3,4,5 Dose (μGy)6,7
AP Spine Thick 1.500 15.1 x 12.1 96 74
AP Spine Thin 0.375 15.1 x 12.1 56 10
Femur Thick 1.500 15.1 x 12.1 96 74
Femur Standard 1.500 15.1 x 12.1 56 42
Femur Thin 0.375 15.1 x 12.1 56 10
DualFemur Thick 1.500 2 x 15.1 x 12.1 192 74
Specifications
Typical Mea-
Total Body Thin 0.150 153.5 x 60 295 0.4
Total Body Small (N/A 0.150 100.9 x 40.1 540 1.8

for Primo
Lateral BMD Standard 3.000 15.1 x 12 56 83
LVA Standard 3.000 38.7 x 15.0 175 83
APVA Thick 3.000 38.7 x 15 85 37
APVA Standard 3.000 38.7 x 15 85 37
APVA Thin 0.750 38.7 x 15 85 9

Knee (N/A on
Primo)
Orthopedic Thick 3.000 20.2 x 15 91 83

Hip
Specifications
Typical Mea-
Orthopedic Standard 3.000 20.2 x 15 44 37

Hip
Orthopedic Thin 0.750 20.2 x 15 44 9

Hip
1 All modes are 76kV, ±5%.

2 Tube current is ±20%.
3 Imaging time measured from shutter open to shutter close, 90% to 100% of
indicated value.
4 Sizes of measurement areas and irradiation times will be less than those listed above
5Measurement lengths and times are dependent on patient height and product
version.
6 Dose measurements are constrained by Daily QA limits. For example, the maximum
spine (standard mode) range is 25 to 85 μGy for Prodigy bone densitometers. To
simulate an average patient, 10 cm of acrylic is used for back-scatter material.
7 Irradiation times and dose values do not consider a “sweep retry” feature, which can
double the dose for a single transverse sweep within an entire scan. If a retry occurs,
a slight increase in irradiation time and skin entrance dose would be expected. On
Prodigy scanners DF+13000 and above, and all Prodigy Advance/Primo scanners, a
sweep may be retried one time during acquisition. A maximum of two sweeps can be
retried per scan. The retry feature reduces the need to rescan the entire patient.
8Femur AFF modes consist of two exposures, one for the distal and the other for the
proximal femur, which use different exposure factors.
Specifications
DPX Series
DPX NT/Pro/Duo/Bravo current and typical dose
Typical Mea-
surement Estimated
Current Area (L cm Irradiation Skin Entrance
Site Mode1 (mA)2 x W cm)4,5 times (sec)3,4,5 Dose (μGy)6,7
AP Spine Thick 1.500 15.1 x 12.1 215 41
AP Spine Thin 0.375 15.1 x 12.1 215 5
AP Spine QuickView Not

available
Femur Detail 1.500 14.0 x 12.0 221 41
Femur Thick 1.500 14.0 x 12.0 221 41
Femur Standard 1.500 14.0 x 12.0 132 20
Femur Thin 0.375 14.0 x 12.0 221 5
Femur QuickView Not

available
DualFemur Thick/ 1.500 2 x 14.0 x 12.0 443 41

Detail
DualFemur QuickView Not

available
Specifications
Typical Mea-
surement Estimated
Hand Standard Not

available
Total Body Thin 0.100 152.0 x 60 894 0.2
Lateral BMD Standard 1.500 12.0 x 12.0 189 41
LVA Standard Not

available
APVA Thick Not

available
APVA Standard Not

available
APVA Thin Not

available
Orthopedic Thick 1.500 20.1 x 15.0 385 41

Hip
Specifications
Typical Mea-
surement Estimated

Hip
Orthopedic Thin 0.375 20.1 x 15.0 385 5

Hip
Small Animal Standard Not

available
DPX-MD+ current and typical dose
Standard mode is replaced with Standard-MD mode.
Typical Mea-
surement Estimated
Site Mode1 (mA)2 x W cm)4,5 Times (sec)3,4,5 Dose (μGy)6,7
AP Spine Standard - 0.750 15.0 x 12.0 212 20

MD
Femur Standard - 0.750 15.0 x 12.0 236 20

MD
Orthopedic Standard - 0.750 15.0 x 12.0 236 20

Hip MD
1 All modes are 76kV, ±5%.

2 Tube current is ±20%.
3 Imaging time measured from shutter open to shutter close, 90% to 100% of
indicated value.
4 Sizes of measurement areas and irradiation times will be less than those listed above
Specifications
5Measurement lengths and times are dependent on patient height and product
version.
6 Dose measurements are constrained by Daily QA limits. For example, the maximum
spine (standard mode) range is 8 to 28 μGy for DPX series bone densitometers. To
simulate an average patient, 10 cm of acrylic is used for back-scatter material.
7 Irradiation times and dose values do not consider a “sweep retry” feature, which can
double the dose for a single transverse sweep within an entire scan. If a retry occurs,
a slight increase in irradiation time and skin entrance dose would be expected. On
DPX series scanners running version 8 software and newer, a sweep may be retried
one time during acquisition. A maximum of two sweeps can be retried per scan. The
retry feature reduces the need to rescan the entire patient.
IEC and UL/CSA Certification

To maintain electrical safety, all computer equipment and accessories connected
to the scanner must meet all requirements for safety. USA and Canada require
UL/CSA and FCC certification. European countries require CE mark certification.
Other countries should follow their local requirements for computer equipment and
accessories certification. Declarations of conformity to the required standards
should meet or exceed the requirements of EN 60950, Safety of Information
Technology Equipment and EN 55024 Information Technology Equipment - Immunity
Characteristics.
Electromagnetic Interference
Although the scanner meets safety standards regarding electromagnetic interference
(EN60601-1-2), you may still experience a loss of performance under extreme
electromagnetic conditions. Maximize the distance between the scanner and other
equipment. Use a dedicated power line to avoid interference to and from the scanner.
Electromagnetic Compatibility (EMC)

Performance
All types of electronic equipment may characteristically cause electromagnetic
interference with other equipment, either transmitted through air or connecting
cables. The term EMC (Electromagnetic Compatibility) indicates the capability of
equipment to curb electromagnetic influence from other equipment and at the same
time not affect other equipment with similar electromagnetic radiation from itself.
Proper installation following the service manual is required in order to achieve the full
EMC performance of the product. In case of issues related to EMC, please call your
service personnel.
Specifications
EMC Environment and Guidance
Recommended Separation Distance

The bone densitometers are intended for use in an electromagnetic environment
in which radiated RF disturbances are controlled. The user can help prevent
electromagnetic interference by maintaining a minimum distance between
RF communications equipment (transmitters) and the bone densitometer
as recommended below, according to the maximum output power of the
communications equipment.
These guidelines may not apply in all situations. Electromagnetic propagation is
affected by absorption and reflection from structures, objects, and people.
Recommended Separation Distance between Portable and Mobile RF
Communications Equipment and the Lunar Densitometer
Rated maximum Separation distance according to frequency of transmitter
output power of in meters
transmitter W
150 kHz to 80 MHz 80 MHz to 800 800 MHz to 2.5
MHz GHz
0.01 0.1 0.1 0.2
0.1 0.4 0.4 0.8

1.0 1.2 1.2 2.4
10 3.7 3.7 7.4
100 12 12 23
Note 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency
range applies.
Note 2: Use of transmitters above 2.5 GHz is not recommended.
Declarations of Immunity and Emissions
Declaration of Electromagnetic Emissions

The bone densitometers are intended for use in the electromagnetic environment specified below. The user of
the bone densitometer should assure that it is used in such an environment.
Emissions test Compliance Electromagnetic environment
guidance
RF emissions Group 1 The bone densitometer uses RF
CISPR 11 energy only for its internal function.
Therefore, its RF emissions are very
low and are not likely to cause any
interference in nearby electronic
equipment.
Specifications
RF emissions
CISPR 11 Class A The bone densitometer is suitable
for use in all establishments,
Harmonic emissions Class A other than domestic, and those
IEC 61000-3-2 directly connected to the public
low-voltage power supply network
Voltage fluctuations / flicker Complies that supplies buildings used for
emissions domestic purposes.
IEC 61000-3-3 Caution: This equipment is not
intended for use in residential
envrionments and may not provide
adequate protection to radio
reception in such environments.
The EMISSIONS characteristics of this equipment make it suitable for use in industrial
areas and hospitals (CISPR 11 class A). If it is used in a residential environment (for
which CISPR 11 class B is normally required) this equipment might not offer adequate
protection to radio-frequency communication services. The user might need to take
mitigation measures, such as relocating or re-orienting the equipment.
Declaration of Electromagnetic Immunity

The bone densitometers are intended for use in the electromagnetic environment specified below. The user of
the bone densitometer should assure that it is used in such an environment.
Immunity test IEC 60601 test Compliance level Electromagnetic environment guidance
level
Electrostatic DPX Series: DPX Series: Floors should be wood, concrete or ceramic
discharge (ESD) ±6 kV contact ±6 kV contact tile. If floors are covered with synthetic
IEC 61000-4-2 material, the relative humidity should be at
±8 kV air ±8 kV air least 30 %.
iDXA, Prodigy iDXA, Prodigy
Series: Series:
±8 kV contact ±8 kV contact
±15 kV air ±15 kV air
Electrical fast ±2 kV for power ±2 kV for power Mains power quality should be that of a
transient/burst supply lines supply lines typical commercial or hospital environment.
IEC 61000-4-4 ±1 kV for ±1 kV for
input/output lines input/output lines
Surge ±1 kV line to line ±1 kV line to line Mains power quality should be that of a
IEC 61000-4-5 ±2 kV line to earth ±2 kV line to earth typical commercial or hospital environment.
Voltage dips, short <5 % UT (>95 % dip <5 % UT (>95 % dip If the user of the bone densitometer requires
interruptions and in UT) for 1 cycle in UT) for 1 cycle continued operation during power mains
voltage variations 70 % UT (30 % dip 70 % UT (30 % dip interruptions, it is recommended that the
on power supply in UT) for 25 cycles in UT) for 25 cycles bone densitometer be powered from an
input lines uninterruptible power supply.
<5 % UT (>95 % dip <5 % UT (>95 % dip
IEC 61000-4-11 in UT) for 5 s in UT) for 5 s
Specifications
Power frequency DPX Series: DPX Series:

magnetic field 3 A/m 3 A/m Mains power quality should be that of a
IEC 61000-4-8 typical commercial or hospital environment.
iDXA, Prodigy iDXA, Prodigy
Series: Series:
30 A/m 30 A/m
Radio frequency (RF): RF communications equipment should be
used no closer to any part of the bone
densitometer (including cables) than the
recommended separation distance.
The recommended separation distance is
calculated using the equation applicable
to the frequency of the transmitter, where
P is the maximum output power rating
of the transmitter in watts (W) according
to the transmitter manufacturer, and d is
the recommended separation distance in
meters (m):
Conducted RF 3 Vrms 3 Vrms d = 1.2 √P (150 kHz to 80 MHz)
IEC 61000-4-6
Radiated RF 3 V/m 3 V/m d = 1.2 √P (80 MHz to 800 MHz)

IEC 61000-4-3 d = 2.3 √P (800 MHz to 2.7 GHz)
DPX Series is tested up to 2.5 GHz.
Note 1: UT is the A.C. mains voltage prior to application of the test level.
Note 2: At 80 MHz and 800 MHz, the higher frequency range applies.
Note 3: These guidelines may not apply in all situations. Electromagnetic propagation is affected by
absorption and reflection from structures, objects, and people.
This equipment is suitable for use in industrial areas and hospitals (except for
near active HF surgical equipment and the RF shielded room of an MRI, where
electromagnetic disturbances are high). Loss of performance (inaccurate bone density
results) due to electromagnetic disturbances may be indicated by artifacts within
scan images or failure of quality assurance tests. If such indicators are encountered,
increase the distance between RF generating equipment and the bone densitometer.
WARNING
Use of the bone densitometer adjacent to or stacked with other equipment should be
avoided. Use of accessories and cables other than those provided by GE Healthcare
could result in increased electromagnetic emissions or decreased electromagnetic
immunity of this equipment. Portable RF communications equipment (including
peripherals such as antenna cables and external antennas) should be used no closer
than 30 cm (12 inches) to any part (including cables) of the bone densitometer. Failure
to do so could result in improper operation.
Minimum PC Requirements
The enCORE computer must meet the requirements listed in this section.
Specifications
Lunar iDXA Series PC requirements
Item Requirement
Intel Processor Intel Core i3
Scanner Dedicated onboard 10/100 Mbit Ethernet

Communications
Keyboard/Mouse USB
RAM 2 GB
Video SVGA (1024x768 24/32 bit color)
Hard Drive 250 GB

1 GB must be available for enCORE
Network Interface (InSite 10/100 Mbit Ethernet

Connectivity)
iDXA systems require additional NIC to support
Internet connection.
Optical Drive DVD-R
Archive 320 GB USB hard drive
Audio Optional
Fax Modem (optional) Class 1 Group 3 (e.g., US Robotics 56k USB

modem - GE Healthcare P/N LU44323)
Monitor 17” SVGA (minimum resolution 1024x768 32 bit

color)
Specifications
Item Requirement
Printer Hewlett-Packard 2250, 2280, 5400, 5650, 8000,

or equivalent
Additional Software Windows 7 Professional 32-bit or 64-bit with SP1,

Internet Explorer 11, Adobe Reader 9.0 or greater.
Email client (optional): Outlook 2003, 2007, 2010
or Windows Live Mail 2011
Prodigy/DPX series PC requirements
Item Requirement
Scanner Onboard RS-232 115K baud DB-9

Communications
Keyboard/Mouse USB
RAM 2 GB
Hard Drive 250 GB


Connectivity)
Optical Drive DVD-R
Audio Optional
Specifications
Item Requirement


color)

or equivalent
Additional Software Windows 7 Professional 32-bit or 64-bit with

SP1, Internet Explorer 11, Adobe Reader 9.0 or
greater.
P4-P7 Prodigy Systems < 301000
Item Requirement
Scanner 1Sealevel PCI serial adapter 7102-2216 (GE

Communications Healthcare P/N LU7151)
Keyboard/Mouse USB
RAM 2 GB
Hard Drive 250 GB


Connectivity)
Optical Drive DVD-R
Specifications
Item Requirement
Audio Optional


color)

or equivalent
Additional Software Windows 7 Professional 32-bit or 64-bit with SP1,

Internet Explorer 11, Adobe Reader 9.0 or greater.
1 Requires full height PCI slot
Safety and Compliance

Ensure that the host computer and components meet the necessary safety and
regulatory requirements for the local market.
● Safety: IEC 60950-1 / EN60950-1 or equivalent such as CE, UL, CSA

● EMC: FCC (USA) or CISPR 22 / EN 55022 or CISPR 32 / EN 55032 or equivalent
● Environmental: WEEE and RoHS Directives
Specifications
Reference Data
B
enCORE Reference Data
enCORE reference data are based on healthy, ambulatory subjects from the general
population who were free from chronic diseases affecting bone, and not taking
bone-altering medications. The first section describes how reference data are
displayed during analysis. The principles described in this section apply in general to
all skeletal regions. The second section describes the reference data in detail. Use of
reference data is entirely at the discretion of the clinician. Unless otherwise noted, all
values used as examples apply to female USA (Lunar) reference data.
Using the Reference Population Comparison

Comparison of patient results to a reference population is entirely at the discretion
of the clinician. By default, the program does not display the comparative values
when shipped from GE Healthcare. If the clinician chooses to use the reference
population data, the program displays the reference sources on the screen and the
analysis reports.
Reference data is updated from time to time as new information becomes available
from additional studies. This might result in multiple reference populations available
for some countries.
These reference populations are available for the U.S. :
● USA (Lunar). Lunar BMD reference data are based on ambulatory subjects from
the general U.S. population who were free from chronic diseases affecting bone
and who were not taking medications that influence bone (e.g., corticosteroids,
anticonvulsants, thyroxin). Reference data is available for adult spine (L1-L4 and
all permutations), femur (neck, wards, troch, total), total body (total), and forearm
(radius UD, radius 33%, radius total)and pediatric spine (L1-L4 and all permutation),
femur (neck, wards, troch, total), and total body (total, TBLH).
● USA (Combined NHANES/Lunar). Contains adult female femur (neck, troch, total)
and male femur (total) reference data from the NHANES III study conducted from
1988 to 1994 based on a representative sample of the U.S. population. Other
regions and scan sites use USA Lunar reference data.
● USA (Combined BMDCS/Lunar). Contains pediatric spine (L1-L4), femur (neck,
total), and total body (total) data from the NICHD BMDCS study conducted from
2002-2006 based on a representative sample of healthy, normally developing U.S.
children. Adults use USA Lunar reference data.
● USA (Combined BMDCS/NHANES/Lunar). Contains pediatric spine (L1-L4), femur
(neck, total), and total body (total) data from the NICHD BMDCS study and adult
Reference Data
female femur (neck, troch, total) and male femur (total) reference data from the
NHANES III study. Other regions and scan sites use USA Lunar reference data.
● USA (NHANES 1999-2004). Contains adult and pediatric total body reference data
from the NHANES study conducted from 1999 to 2004 based on a representative
sample of the U.S. population.
Other available reference populations are: Asia, Australia (Combined Geelong/Lunar),
Australia (Geelong), Australia (Lunar), Brazil, China, Egypt, Finland, France, Germany,
Indonesia, Italy, Japan (JSBMR 2011), Japan (Lunar), Korea, Mexico, Middle East,
Philippine, Spain, Tunisia, Turkey, and UK.
Choosing Reference Population Options

enCORE software allows comparison of a patient’s results to a reference population.
Follow these instructions to change the reference population options. After you make
changes to these settings, you must reanalyze scan files to incorporate the changes.
1. Select Tools > User Options > Reference Data tab > Reference Population
Options button.
The Reference Population Options dialog box appears.
Reference Population Options
2. The measurement sites are listed in the Sites section of the dialog box. Choose a
site by clicking the site name.
Reference Data
3. Select the reference population you want to use from the list of Available
Reference Populations.
The Available Reference Populations list lets you choose the reference population
to which your patient data will be compared. A different reference population can
be selected independently for each measurement site, or the Use same Reference
Population for all sites option lets you use the same population for all sites.
Enable this option to use the currently selected reference population for all sites.
4. The Default Region list lets you choose the default region for analysis for each site.
5. Choose the reference population options you want to use by checking the boxes
in the Reference Settings section.
The available options are site-specific:
● Young Adult (T-score) allows comparison to the reference population mean
value for a healthy young adult of the same sex as the patient. When this
option is selected, you can access the %Young Adult and T-score data during
analysis.
● Age Matched (Z-score) allows comparison to the reference population subjects
of the same age and sex as the patient. When this option is selected, you can
access the %Age-Matched and Z-score data and the Age Matched regression
bar during analysis.
● Ethnic Adjustment factors ethnic origin (Black, White, Asian, or Hispanic) into
the age-matched comparison. This option is not available for Lateral Vertebral
Assessment (LVA). You can only use this option if the Age Matched (Z-score)
option is selected.
● Height Adjustment is only available for the LVA site. When this option is
selected, the subject’s vertebral heights are normalized by the ratio of the
reference population’s average L2-L4 height to the subject’s average L2-L4
height and then compared with the reference heights at each level. This option
is selected whenever the Age Matched (Z-score) option is selected and cannot
be disabled.
● Weight Adjustment adjusts the age-matched comparison for the patient’s
weight. This option is not available for the LVA site. Weight adjustment is only
possible if the Age Matched (Z-score) option is selected.
6. Click OK to save the changes.
Configuring the Comparison to Reference Graph

The Reference Graph Options dialog box appears when you select Tools > User
Options > Results Display tab > Reference Graph Options button. This dialog box
lets you configure the Comparison to Reference Graphs for all sites.
Reference Data
Reference Graph Options dialog box
The following paragraphs describe the features in the dialog box. When a feature is
selected, that feature appears on the graph.
● Standard Deviation Bars lets you turn the standard deviation bars on and off.
These bars are the colored bars that appear on the graph.
● Show Secondary Y-Axis lets you turn the y-axis on the right side of the reference
graph on and off. The secondary y-axis shows the YA T-score or AM Z-score when
applicable.
● Center Line determines if a centerline appears in the Age-Matched regression bar.
The centerline marks the average BMD value.
● 1st Bar and 2nd Bar let you choose how many Age-Matched regression bars to
display (±1 SD or ±2 SD). Check one box to display one regression bar (e.g., ±1 SD or
±2 SD) or both boxes to display two (e.g., ±1 SD and ±2 SD).
● The Solid check box next to each bar option determines the color of the regression
bar. If selected, the bar is blue. Otherwise, the bar is clear.
● The SD text boxes let you set the standard deviation for each bar. A 1.00 SD means
the bar extends 1 SD above and 1 SD below the centerline. To change an SD value,
click inside the appropriate text box, delete the old value, and enter the new value.
Reference Data Populations

The following tables contain the supported sites and analysis types for each of the
distributed Reference Data Populations supported by enCORE.
Reference Data
Site / Asia Australia Australia Australia Brazil China

Analysis Type (Combi- (Geelong) (Lunar)
ned
Geelong/
Lunar)
AP Spine Densitometry X X X1,13 X X X
Femur Densitometry X X X1 X X X
Femur HAL (AHA) X1,2 X1,4 X1,4 X1,4 X1,2
Total Body Densitometry X5 X5 X5 X5 X5
Total Body Composition X2,5 X4,5 X4,5 X4,5 X2,5
Lateral Spine Densitometry X1 X X X X1
Forearm Densitometry X X X X X
Pediatric Spine Densitometry X X X
Pediatric Total Body Densitometry X7 X9 X9 X9 X7
Pediatric Femur Densitometry X8 X8 X8
Pediatric Growth X X X
Pediatric Total Body Composition
Total Body Composition Indices
Site / Egypt Finland France Germany Indonesia

Analysis Type
AP Spine Densitometry X1 X X X X
Femur Densitometry X1 X X X X
Reference Data
Site / Egypt Finland France Germany Indonesia

Analysis Type
Total Body Densitometry X5 X1,5 X5
Total Body Composition X X4,5
Lateral Spine Densitometry X X1 X
Forearm Densitometry X1 X X X
Pediatric Spine Densitometry X X
Pediatric Total Body Densitometry X9 X9
Pediatric Femur Densitometry X8 X8
Pediatric Growth X X
Site / Italy Japan Japan Japan Korea Mexico Middle

Analysis Type (JSBMR (JSBMR (Lunar) East
2011) 2012)
AP Spine Densitometry X X1,14 X18 X X X X
Femur Densitometry X X1,15 X19 X X X X
Total Body Densitometry X1,5 X5 X5
Reference Data
Site / Italy Japan Japan Japan Korea Mexico Middle

Analysis Type (JSBMR (JSBMR (Lunar) East
2011) 2012)
Total Body Composition X2,5 X2,5
Lateral Spine Densitometry X X1 X1
Forearm Densitometry X X X X
Pediatric Spine Densitometry X
Pediatric Total Body X9

Densitometry
Pediatric Femur Densitometry X8
Pediatric Growth X
Pediatric Total Body

Composition
Site / Philippine Spain Tunisia Turkey UK

Analysis Type
AP Spine Densitometry X1 X X1 X X
Femur Densitometry X1 X X1 X X
Total Body Densitometry X1,5 X5 X5
Total Body Composition X4,5
Reference Data
Site / Philippine Spain Tunisia Turkey UK

Analysis Type
Lateral Spine Densitometry X X
Forearm Densitometry X1 X X
Pediatric Spine Densitometry X X
Pediatric Total Body Densitometry X9 X9
Pediatric Femur Densitometry X8 X8
Pediatric Growth X X
Site / USA USA USA USA USA

Analysis Type (Combined (Combined (Combined (Lunar) (NHANES
BMDCS/ NHANES/ NHANES/ 1999-2004)
Lunar) BMDCS/ Lunar)
Lunar)
AP Spine Densitometry X X X X
Femur Densitometry X X X X
Femur HAL (AHA) X1,4 X1,4 X1,4 X1,4
Total Body Densitometry X5 X5 X5 X5 X5,10,16,17
Total Body Composition X4,5 X4,5 X4,5 X4,5 X5,10,17
Lateral Spine Densitometry X X X X
Reference Data
Site / USA USA USA USA USA

Analysis Type (Combined (Combined (Combined (Lunar) (NHANES
BMDCS/ NHANES/ NHANES/ 1999-2004)
Lunar) BMDCS/ Lunar)
Lunar)
Forearm Densitometry X X X X
Pediatric Spine Densitometry X X X X
Pediatric Total Body Densitometry X3,6 X3,6 X9 X9 X10,16,17
Pediatric Femur Densitometry X X X X8
Pediatric Growth X X X10,11,17
Pediatric Total Body Composition X10,17
Total Body Composition Indices X10,12,17
1 Females only
2 Asians only
3 The data supports comparisons to both BMD and BMC (BMC for Basic Analysis only)
4 Whites only
5 Total region only
6 No TBLH support
7 Basic Analysis exams only, for TBLH
8 Whites, Asians and Hispanics only, for Troch and Shaft
9 Whites, Asians and Hispanics only, for TBLH
Reference Data
10 Whites, Blacks and Hispanics
11 Height versus Age is not supported
12 Only Lean/Ht 2 vs Age is supported for Pediatric Total Body
13 OneScan AP Spine exams are not supported
14 L2-L4 region only
15 Neck region only
16 BMD and BMC
17 Enhanced Analysis only
18 L1-L4 and L2-L4 regions only
19 Neck and Total regions only
Adult Reference Data
C
Bone Mineral Density (BMD)
The bone mineral density (BMD) value gives the area density in g/cm2 for a selected
region. enCORE software plots a patient’s BMD versus age on the Reference graph.
The figure below shows a 70-year old female patient with a spine BMD value of 0.990
g/cm2. Numerical divisions on the right and left sides of the graph correspond to
intervals of one standard deviation (SD).
Female reference graph with Age-Matched regression bar for 70- year old patient
%Young Adult
The %Young Adult (%YA) value compares a patient’s BMD with the expected Young
Adult (YA) BMD for a subject 20-39 years old of the same sex and nationality. Young
adult reference values are set at age 30 for all but Australia/Geelong and NHANES
reference data, which are set at age 25 years. The green bars at the top of the
graph show the normal range of spine L1-L4 BMD values for young adults. For USA
white females, the YA Spine BMD value is 1.18 g/cm2. Each change in BMD shown
at the left of the graph represents one standard deviation (SD) from the YA BMD.
These values correspond to the SD changes noted on the right axis of the graph.
The standard deviation for an adult white female AP (anteroposterior) spine L1-L4 is
0.12 g/cm2. Notice that the BMD value below 1.18 at the left of the graph is 1.06,
representing 1 SD below the YA value. This agrees with the –1 noted on the right axis.
The table accompanying the graph shows that this patient’s BMD is 84% of the YA
BMD (0.990/1.18 = 84%).
The program also calculates the patient’s Young Adult T-score. The T-score is the
number of SDs the patient’s BMD is above or below the Young Adult mean value. The
patient plotted in Bone Mineral Density (BMD) (339) has a T-score of –1.6, indicating
the patient’s BMD value is 1.6 SDs below the Young Adult mean value ((0.990 –
1.18)/0.12 = -1.6).
%Age-Matched
The %Age-Matched value compares the subject’s BMD with the average BMD of a
reference group of the same age and sex, and, optionally, with the same weight and
ethnicity. This Age-Matched comparison is displayed as the regression bar on the
Reference graph. The regression bar refers to the area that begins as light green,
with upper and lower limits of 1.3 and 1.06 BMD in Bone Mineral Density (BMD) (339).
The Age-Matched comparison is used to determine if the patient deviates from the
reference pattern for the patient’s age, sex, and, optionally, weight and/or ethnicity.
The line in the middle of the bar marks the expected BMD value at each age. The
areas above and below the centerline indicate one SD above and below the mean
BMD for any age.
The graph shows there is little change in lumbar spine BMD until age 45, when a
decrease begins. This age-related decline must be factored into the final analysis of
the patient’s results. A BMD value that falls below the Age-Matched bar suggests that
factors other than aging may be affecting the patient’s BMD value. The program also
calculates the patient’s Age-Matched Z-score. The Z-score is the number of SDs the
patient’s BMD is above or below the Age-Matched mean value. The subject’s BMD
plotted in Bone Mineral Density (BMD) (339) has a Z-score of 0.1, because the BMD
value of 0.990 is 0.1 SDs above the Age-Matched mean value of 0.978 g/cm2 for a
70-year old woman ((0.990-0.978)/0.12 = 0.10). This value means that this subject’s
BMD is near average for her age.
The figure below shows a 45–year-old subject who has the same BMD (0.990g/cm2)
as the 70-year-old female shown in Bone Mineral Density (BMD) (339). Unlike the
70-year-old patient who is within the Age-Matched regression bar and, thus, has
normal BMD for her age, the 45-year-old patient is well below the bar, indicating that
factors other than aging may be causing her bone loss. Secondary causes of bone
loss include a variety of endocrine disorders, eating disorders, gastrointestinal and
liver disorders, cancer, kidney disease, bone marrow-related disorders and adverse
effects of drug therapy.110, 111
Female Reference Graph with Age-Matched regression (45-year-old patient)
%Age-Matched: Weight Adjustment

Subject weight affects BMD values.9-12 Heavier subjects typically have higher BMD
values and lighter subjects typically have lower BMD values than average-weight
subjects.
When you enable the weight option, software adjusts the expected age-matched
value by 0.004g/cm2 for AP spine BMD and 0.003 g/cm2 for femur BMD for each
kilogram (kg) that a patient’s weight deviates from the mean weight. The software
shifts the Age-Matched regression bar up if a patient is heavier than the mean weight
for a given gender and down if the patient is lighter than the mean weight. The mean
weight for white females in the USA (Lunar) database is 65 kg (males 78 kg). The
weight adjustment does not affect the %Young Adult values or Young Adult T-scores,
only the Age-Matched values.
The figure below shows a patient with the same BMD results as before, but the patient
now weighs 85 kg rather than 65 kg. Notice the Age-Matched regression bar has
shifted up to adjust for this additional weight. The peak Age-Matched BMD for age
20-45 that previously was 1.18 g/cm2 is now 1.26 g/cm2 (1.18 + (85-65) x 0.004 = 1.26).
AP spine and femur adjustments are applied for weights between 25 and 100 kg.
Data suggest an additional weight adjustment for subjects over 100 kg or less than
25 kg is not necessary.
Female reference graph with Age-Matched regression for weight set at 85 kg
%Age-Matched Ethnicity Adjustment

The Ethnicity adjustment lets you factor ethnic origin (black, white, Asian, or Hispanic)
into the final Age-Matched comparison. Reference values for black populations are
typically 8-12% greater than those for white.13-22 The software shifts the regression
bar up if the reference population values are greater than those for white, and down if
less than white. The Ethnicity adjustment, like the Weight adjustment, only affects the
Age-Matched regression bar. It does not affect the %Young Adult values and T-scores.
The Ethnicity adjustment within a reference population should not be confused with
specific, nationality-based reference data (e.g., China, USA).
%Age-Matched Nationality Reference Database

enCORE software allows the use of nationality-based reference data such as Chinese,
French, Middle Eastern, and Japanese. The selected nationality affects the location
and shape of the age-matched regression bar. For example, if you choose the French
reference data for the spine, the female regression bar for young adults will be lower
than the USA white regression bar, and the middle section of the regression bar will
have a steeper slope than the USA white regression bar. These differences reflect the
smaller body size in the average French adult compared to U.S. adults and the more
rapid BMD decline with age in the French population.50
Reference Graph: Female and Male

The previous figures are female reference graphs. The male reference graph below
is based on the same principles, but has a somewhat higher YA BMD and a different
Age-Matched regression bar. Compare the graph in Bone Mineral Density (BMD) (339)
(female AP spine) with the figure below (male AP spine) to see the differences. Notice
that the Young Adult BMD at age 20 is 1.22 for males compared with 1.18 for females,
and the male regression bar declines less after age 45 than for females.
Male reference graph for spine (L1-L4) BMD
Reference Graphs: Other Sites

The figures above show the reference graph for L1-L4 region of AP spine. The
reference graphs for other sites use the same principles as the AP spine, but use
different Young Adult values and Age-Matched regression bars. For example, results
of a dual femur scan for a 52 year-old White female are shown in the figure below.
Female reference graph for DualFemur total BMD
Bone Mineral Density Reference Populations

Lunar BMD reference data are based on ambulatory subjects from the general
population who were free from chronic diseases affecting bone and who were not
taking medications which influence bone (e.g., corticosteroids, anticonvulsants,
thyroxin).
Reference values from a number of white populations have been shown to be virtually
identical (U.S., Australia, Spain, Brazil, Argentina, and Finland).1-7 Variations within
normal limits of nutrition and physical activity have not been demonstrated to have a
significant influence on reference values, but body weight does have some influence.1,
8-12 Race also can have an influence on BMD. For example, BMD in black subjects is
about 8-12% more dense than in white subjects.13-22 Hispanics have a somewhat
higher BMD (2-4%) than whites.20, 23 People of Asian descent have somewhat lower
BMD than black or Caucasian subjects, a finding that is at least partly associated
with smaller body size.24-26
Comparison to Young Adult

Young Adult White BMD values are a subset of density values for White subjects 20-39
years of age. Comparison to Young Adult takes the subject’s BMD, regardless of
age, and compares it with the mean value for subjects of the same sex in the same
reference population from 20-39 years of age. Choose the Young Adult option from
the Reference Data Options dialog box to turn on Comparison To Young Adult.
Comparison to Age-Matched
Bone mass and density decrease with aging in males and females. The exact
magnitude of the effect cannot be assessed from studies of cross-sectional data in
groups because of inter-individual variation. Longitudinal studies of individual females
usually show a consistent progression of losses following menopause.27-48 Data from
the USA (Lunar) reference population are plotted in the figures below and listed in the
tables in Age Adjustment (350).
Male and female USA (Lunar) reference values for spine L1-L4
Male and female USA (Lunar) reference values for femur neck and total BMD
USA (Combined NHANES/Lunar) reference values for femur neck and total femur reference values
Male and female USA (Lunar) reference values for Total Body BMD
Male and female USA (Lunar) reference values for Radius 33% Shaft and Radius Total BMD
Male and female USA (Lunar) age-related reference for lateral L2-L3 body
Effect of Postmenopausal Years

Studies of bone change in normal women49-59 have shown that bone loss in females
begins near menopause at many skeletal sites. Bone loss has been estimated at
10% over the first 5 years after menopause, but the effect can be modified by the
individual’s estrogen status and body weight.9-12 Women with body weight >20%
above average may lose no bone at menopause. The proximity of the measurement
to menopause should be taken into account when interpreting results.27-39, 60-62
Subjects with an early menopause may have lower results than expected for their age,
while obese subjects or subjects with late menopause may have results higher than
expected for their age.
A person’s BMD cannot be extrapolated forward in time to indicate future bone loss.
Some subjects may have a low BMD because of genetic factors or influences during
growth and development, while others may have had an episode affecting bone
during adulthood (e.g., corticosteroid use, immobilization) that no longer occurs.
Detailed longitudinal observations show no distinct subpopulations with high rates of
bone loss.61-62
Reference Population Database

Lunar USA/Northern European reference values are supported by a large database
from studies of a number of the reference populations.1-3, 6, 33, 36, 39, 51-59, 63-73 These
studies were conducted at university medical centers and clinics in the U.S., England,
and Northern Europe. The variation of mean BMD values among geographical sites
contributing reference data was about 1.3% (SD/mean). Additional reference data
were acquired from a variety of other geographic regions.50, 74-94
Age Adjustment
Age-Matched comparisons use age regressions to calculate an expected BMD. The
subject’s BMD is compared with the expected BMD for a person of the same age and
gender in the reference population. Age-Matched BMD reference values are shown in
the tables below, broken out by decade.
Reference Values for Spine
Female reference values for Spine L1-L4
Female YA BMD, SD, and reference values at 10-year intervals for AP Spine (L1-L4).
YA SD 25 yr 35 yr 45 yr 55 yr 65 yr 75 yr 85 yr
Asia 1.112 0.12 1.112 1.112 1.112 0.992 0.872 0.807 0.797
Australia/ 1.207 0.1324 1.207 1.207 1.207 1.135 1.063 0.994 0.925
Geelong
USA/N. Europe 1.180 0.12 1.180 1.180 1.180 1.085 0.990 0.970 0.950
China 1.114 0.12 1.114 1.114 1.114 0.991 0.868 0.792 0.762
Egypt 1.150 0.12 1.150 1.150 1.150 1.050 0.950 0.940 0.930
Finland 1.170 0.12 1.170 1.170 1.170 1.045 0.920 0.900 0.880
France 1.160 0.12 1.160 1.160 1.105 0.995 0.885 0.855 0.825
Indonesia 1.110 0.12 1.110 1.110 1.110 1.025 0.940 0.878 0.816
Italy 1.180 0.12 1.180 1.180 1.130 1.030 0.930 0.900 0.870
Japan (JSBMR 1.152 0.139 1.152 1.152 1.152 0.999 0.887 0.817 0.747
2012)
Japan (Lunar) 1.110 0.12 1.110 1.110 1.110 0.990 0.870 0.840 0.810
Korea 1.149 0.12 1.149 1.149 1.149 1.051 0.953 0.843 0.733
Mexico 1.170 0.12 1.170 1.170 1.120 1.020 0.920 0.895 0.870
Middle East 1.101 0.12 1.101 1.101 1.101 1.021 0.941 0.931 0.921
Philippines 1.110 0.12 1.110 1.110 1.110 0.988 0.866 0.835 0.804
Spain 1.180 0.12 1.180 1.180 1.130 1.030 0.930 0.900 0.870
Tunisia 1.148 0.12 1.148 1.148 1.148 1.018 0.888 0.858 0.828
Turkey 1.136 0.12 1.136 1.136 1.136 1.056 0.976 0.906 0.836
Female reference values for Spine L2-L4

Female YA BMD, SD, and reference values at 10-year intervals for AP Spine (L2-L4).
Japan 1.192 0.146 1.198 1.198 1.198 1.020 0.910 0.868 0.827
(JSBMR 2011)
Japan 1.192 0.143 1.192 1.192 1.192 1.032 0.916 0.846 0.776
(JSBMR 2012)
Male reference values for Spine L1-L4

Male YA BMD, SD, and reference values at 10-year intervals for AP Spine (L1-L4).
Asia 1.131 0.12 1.139 1.124 1.098 1.062 1.026 0.993 0.963
USA/N. Europe 1.220 0.12 1.220 1.220 1.210 1.189 1.168 1.147 1.126
China 1.082 0.12 1.095 1.070 1.045 1.022 0.999 0.980 0.966
Finland 1.210 0.12 1.210 1.210 1.200 1.180 1.160 1.140 1.120
France 1.190 0.12 1.190 1.190 1.179 1.158 1.137 1.116 1.095
Indonesia 1.095 0.12 1.095 1.095 1.095 1.090 1.085 1.075 1.065
Italy 1.220 0.12 1.220 1.220 1.210 1.189 1.168 1.147 1.126
Japan (JSBMR 1.116 0.150 1.116 1.116 1.116 1.086 1.056 0.963 0.869
2012)
Japan (Lunar) 1.180 0.12 1.180 1.180 1.155 1.105 1.055 1.005 0.955
Korea 1.180 0.12 1.180 1.180 1.155 1.105 1.055 1.005 0.955
Mexico 1.180 0.12 1.180 1.180 1.165 1.135 1.105 1.075 1.045
Middle East 1.112 0.12 1.112 1.112 1.112 1.082 1.052 1.042 1.032
Spain 1.220 0.12 1.220 1.220 1.210 1.189 1.168 1.147 1.126
Turkey 1.112 0.12 1.112 1.112 1.112 1.082 1.052 1.042 1.032
Male reference values for Spine L2-L4

Male YA BMD, SD, and reference values at 10-year intervals for AP Spine (L2-L4).
Japan 1.138 0.162 1.138 1.138 1.138 1.110 1.082 0.983 0.884
(JSBMR 2012)
Reference Values for Femur

Female reference values for Femur Neck BMD
Asia 0.915 0.12 0.923 0.907 0.859 0.779 0.699 0.643 0.587
Australia/ 1.018 0.1267 1.018 0.996 0.974 0.921 0.868 0.792 0.716
Geelong
USA/N. Europe 0.980 0.12 0.990 0.970 0.950 0.880 0.810 0.770 0.730
China 0.930 0.12 0.930 0.930 0.893 0.819 0.745 0.671 0.597
Egypt 0.990 0.12 1.0025 0.9775 0.9525 0.900 0.820 0.770 0.750
Finland 0.980 0.12 0.988 0.973 0.958 0.893 0.828 0.788 0.748
France 0.980 0.12 0.990 0.970 0.920 0.840 0.760 0.700 0.640
Indonesia 0.915 0.12 0.915 0.915 0.915 0.831 0.747 0.673 0.599
Italy 0.980 0.12 0.990 0.970 0.950 0.870 0.790 0.750 0.710
Japan (Lunar) 0.900 0.12 0.915 0.885 0.855 0.745 0.635 0.615 0.595
Japan 0.914 0.119 0.961 0.941 0.921 0.823 0.725 0.653 0.580
(JSBMR 2011)
Japan 0.939 0.114 0.939 0.917 0.872 0.812 0.738 0.664 0.590
(JSBMR 2012)
Korea 0.942 0.12 0.947 0.937 0.927 0.870 0.813 0.693 0.573
Mexico 0.980 0.12 1.000 0.960 0.920 0.865 0.810 0.765 0.720
Middle East 0.930 0.12 0.940 0.920 0.900 0.855 0.810 0.740 0.670
NHANES 1.038 0.1390 1.038 0.999 0.960 0.898 0.836 0.772 0.708
Philippines 0.888 0.12 0.892 0.884 0.876 0.801 0.726 0.649 0.572
Spain 0.980 0.12 0.990 0.970 0.950 0.870 0.790 0.750 0.710
Tunisia 1.018 0.12 1.018 1.018 1.018 0.913 0.808 0.736 0.696
Turkey 0.948 0.12 0.958 0.938 0.918 0.898 0.806 0.714 0.674
Female reference values for Total Femur BMD

Asia 0.955 0.125 0.955 0.955 0.921 0.852 0.783 0.710 0.637
Australia/ 1.051 0.134 1.051 1.044 1.037 0.993 0.949 0.870 0.791
Geelong
USA/N. Europe 1.000 0.12 1.005 0.995 0.985 0.925 0.865 0.810 0.755
China 0.975 0.13 0.975 0.975 0.948 0.893 0.825 0.745 0.665
Egypt 1.010 0.12 1.015 1.005 0.995 0.955 0.885 0.840 0.820
Finland 1.006 0.12 1.011 1.002 0.993 0.935 0.877 0.822 0.767
France 1.000 0.12 1.005 0.995 0.951 0.872 0.793 0.731 0.669
Indonesia 0.943 0.12 0.943 0.943 0.943 0.871 0.799 0.723 0.647
Italy 1.000 0.12 1.005 0.995 0.985 0.921 0.857 0.802 0.747
Japan (JSBMR 0.961 0.130 0.961 0.948 0.921 0.868 0.787 0.707 0.627
2012)
Japan (Lunar) 0.934 0.12 0.940 0.929 0.918 0.823 0.728 0.676 0.624
Korea 0.974 0.12 0.974 0.974 0.974 0.937 0.862 0.752 0.642
Mexico 1.010 0.12 1.025 0.995 0.965 0.918 0.871 0.824 0.777
Middle East 0.940 0.12 0.945 0.935 0.925 0.891 0.857 0.814 0.771
NHANES 1.0077 0.126 1.008 0.990 0.972 0.927 0.858 0.790 0.722
Philippines 0.913 0.12 0.913 0.913 0.913 0.863 0.813 0.768 0.723
Spain 1.000 0.12 1.005 0.995 0.985 0.921 0.857 0.802 0.747
Tunisia 1.0414 0.13 1.041 1.041 1.041 0.986 0.876 0.791 0.731
Turkey 0.97725 0.12 0.982 0.972 0.962 0.952 0.882 0.787 0.692
Male reference values for Femur Neck BMD

Asia 0.964 0.12 0.986 0.942 0.898 0.855 0.812 0.768 0.724
USA/N. Europe 1.070 0.13 1.090 1.050 1.010 0.970 0.930 0.890 0.850
China 0.978 0.13 0.998 0.958 0.918 0.878 0.838 0.798 0.758
Finland 1.070 0.13 1.090 1.050 1.010 0.970 0.930 0.890 0.850
France 1.020 0.13 1.044 0.997 0.950 0.903 0.856 0.809 0.762
Indonesia 0.977 0.13 1.0035 0.9505 0.8975 0.8675 0.8375 0.7715 0.7055
Italy 1.070 0.13 1.094 1.047 1.000 0.953 0.906 0.859 0.812
Japan (JSBMR 1.008 0.123 1.008 0.985 0.938 0.888 0.836 0.783 0.731
2012)
Japan (Lunar) 0.950 0.13 0.974 0.927 0.880 0.833 0.786 0.739 0.692
Korea 0.950 0.13 0.974 0.927 0.880 0.833 0.786 0.739 0.692
Mexico 1.070 0.13 1.095 1.045 0.995 0.945 0.895 0.860 0.825
Middle East 1.030 0.13 1.055 1.005 0.955 0.910 0.865 0.820 0.775
Spain 1.070 0.13 1.094 1.047 1.000 0.953 0.906 0.859 0.812
Turkey 1.030 0.13 1.055 1.005 0.955 0.910 0.865 0.820 0.775
Male reference values for Total Femur BMD

Asia 0.966 0.13 0.978 0.954 0.930 0.905 0.880 0.840 0.785
USA/N. Europe 1.090 0.13 1.105 1.075 1.045 1.020 0.995 0.965 0.935
China 0.991 0.13 0.995 0.987 0.979 0.959 0.939 0.899 0.839
Finland 1.090 0.13 1.105 1.075 1.045 1.020 0.995 0.965 0.935
France 1.035 0.13 1.055 1.016 0.977 0.945 0.913 0.874 0.835
Indonesia 1.003 0.13 1.013 0.993 0.973 0.955 0.937 0.875 0.813
Italy 1.090 0.13 1.110 1.071 1.032 1.000 0.968 0.929 0.890
Japan (JSBMR 1.046 0.135 1.046 1.027 0.990 0.952 0.914 0.839 0.763
2012)
Japan (Lunar) 0.941 0.13 0.961 0.922 0.883 0.851 0.819 0.780 0.741
Korea 0.941 0.13 0.961 0.922 0.883 0.851 0.819 0.780 0.741
Mexico 1.090 0.13 1.125 1.055 0.985 0.970 0.955 0.935 0.915
Middle East 1.034 0.13 1.054 1.015 0.976 0.951 0.926 0.859 0.792
NHANES 1.101 0.144025 1.101 1.082 1.062 1.043 1.024 0.975 0.905
Spain 1.090 0.13 1.110 1.071 1.032 1.000 0.968 0.929 0.890
Turkey 1.034 0.13 1.054 1.015 0.976 0.951 0.926 0.859 0.792
Reference Values for Total Body

Female reference values for Total Body BMD — Basic Analysis (Prodigy, DPX-NT)
Asia 1.110 0.09 1.110 1.110 1.110 1.038 0.966 0.923 0.880
USA/N. Europe 1.125 0.08 1.125 1.125 1.125 1.075 1.025 1.005 0.985
China 1.120 0.10 1.120 1.120 1.098 1.054 1.004 0.948 0.892
Finland 1.125 0.08 1.125 1.125 1.125 1.075 1.025 1.005 0.985
France 1.077 0.08 1.077 1.077 1.077 1.037 0.997 0.979 0.961
Italy 1.110 0.08 1.110 1.110 1.110 1.070 1.030 1.012 0.994
Japan (Lunar) 1.100 0.08 1.100 1.100 1.100 1.015 0.930 0.895 0.860
Korea 1.100 0.08 1.100 1.100 1.100 1.015 0.930 0.895 0.860
Spain 1.110 0.08 1.110 1.110 1.110 1.070 1.030 1.012 0.994
Turkey 1.132 0.08 1.132 1.132 1.132 1.107 1.057 0.980 0.903
Female reference values for Total Body BMD — Enhanced Analysis (Prodigy, iDXA)
Asia 1.062 0.11 1.062 1.062 1.062 0.971 0.880 0.826 0.771
USA/N. Europe 1.080 0.10 1.080 1.080 1.080 1.017 0.954 0.929 0.904
China 1.074 0.13 1.074 1.074 1.046 0.991 0.928 0.857 0.787
Finland 1.080 0.10 1.080 1.080 1.080 1.017 0.954 0.929 0.904
France 1.020 0.10 1.020 1.020 1.020 0.969 0.919 0.896 0.874
Italy 1.062 0.10 1.062 1.062 1.062 1.011 0.961 0.938 0.915
Japan (Lunar) 1.049 0.10 1.049 1.049 1.049 0.942 0.835 0.790 0.746
Korea 1.049 0.10 1.049 1.049 1.049 0.942 0.835 0.790 0.746
Spain 1.062 0.10 1.062 1.062 1.062 1.011 0.961 0.938 0.915
Turkey 1.089 0.10 1.089 1.089 1.089 1.058 0.995 0.898 0.800
Male reference values for Total Body BMD – Basic Analysis (Prodigy, DPX-NT)
Asia 1.154 0.09 1.158 1.150 1.135 1.112 1.089 1.066 1.043
USA/N. Europe 1.220 0.08 1.220 1.220 1.220 1.220 1.195 1.170 1.145
China 1.128 0.10 1.132 1.124 1.116 1.113 1.110 1.107 1.104
Finland 1.220 0.08 1.220 1.220 1.220 1.220 1.195 1.170 1.145
Japan (Lunar) 1.180 0.08 1.180 1.180 1.158 1.113 1.068 1.023 0.978
Korea 1.180 0.08 1.180 1.180 1.158 1.113 1.068 1.023 0.978
Turkey 1.220 0.08 1.220 1.220 1.220 1.220 1.195 1.170 1.145
Male reference values for Total Body BMD – Enhanced Analysis (Prodigy, iDXA)
Asia 1.117 0.11 1.122 1.112 1.093 1.064 1.035 1.006 0.977
USA/N. Europe 1.200 0.10 1.200 1.200 1.200 1.200 1.169 1.137 1.106
China 1.084 0.13 1.089 1.079 1.069 1.065 1.062 1.058 1.054
Finland 1.200 0.10 1.200 1.200 1.200 1.200 1.169 1.137 1.106
Japan (Lunar) 1.150 0.10 1.150 1.150 1.122 1.065 1.009 0.952 0.895
Korea 1.150 0.10 1.150 1.150 1.122 1.065 1.009 0.952 0.895
Turkey 1.200 0.10 1.200 1.200 1.200 1.200 1.169 1.137 1.106
Reference Values for Radius

Female reference values for Radius 33% Shaft BMD
Asia 0.850 0.08875 0.850 0.850 0.850 0.750 0.650 0.550 0.450
USA/N. Europe 0.88747 0.08875 0.887 0.887 0.887 0.847 0.767 0.687 0.607
China 0.850 0.08875 0.850 0.850 0.850 0.750 0.650 0.550 0.450
Egypt 0.832 0.07000 0.832 0.832 0.832 0.797 0.727 0.687 0.677
Finland 0.88747 0.08875 0.887 0.887 0.887 0.847 0.767 0.687 0.607
France 0.88747 0.08875 0.887 0.887 0.887 0.847 0.767 0.687 0.607
Italy 0.88747 0.08875 0.887 0.887 0.887 0.847 0.767 0.687 0.607
Japan (Lunar) 0.850 0.08875 0.850 0.850 0.850 0.750 0.650 0.550 0.450
Korea 0.850 0.08875 0.850 0.850 0.850 0.750 0.650 0.550 0.450
Middle East 0.8209 0.08875 0.821 0.821 0.821 0.790 0.728 0.665 0.603
Philippines 0.8110 0.08875 0.816 0.807 0.798 0.736 0.674 0.629 0.584
Spain 0.88747 0.08875 0.887 0.887 0.887 0.847 0.767 0.687 0.607
Female reference values for Radius Total BMD

Asia 0.65687 0.06114 0.657 0.657 0.657 0.588 0.519 0.450 0.380
USA/N. Europe 0.6830 0.06114 0.683 0.683 0.683 0.655 0.600 0.545 0.489
China 0.65687 0.06114 0.657 0.657 0.657 0.588 0.519 0.450 0.380
Finland 0.6830 0.06114 0.683 0.683 0.683 0.655 0.600 0.545 0.489
France 0.6830 0.06114 0.683 0.683 0.683 0.655 0.600 0.545 0.489
Italy 0.6830 0.06114 0.683 0.683 0.683 0.655 0.600 0.545 0.489
Japan (Lunar) 0.65687 0.06114 0.657 0.657 0.657 0.588 0.519 0.450 0.380
Korea 0.65687 0.06114 0.657 0.657 0.657 0.588 0.519 0.450 0.380
Middle East 0.63175 0.06114 0.632 0.632 0.632 0.610 0.567 0.524 0.481
Philippines 0.6455 0.06114 0.647 0.645 0.643 0.590 0.537 0.492 0.447
Spain 0.6830 0.06114 0.683 0.683 0.683 0.655 0.600 0.545 0.489
Female reference values for Radius Ultradistal BMD

Asia 0.449 0.04538 0.449 0.449 0.449 0.397 0.346 0.294 0.243
USA/N. Europe 0.469 0.04538 0.469 0.469 0.469 0.448 0.407 0.365 0.324
China 0.449 0.04538 0.449 0.449 0.449 0.397 0.346 0.294 0.243
Egypt 0.438 0.06000 0.438 0.438 0.438 0.416 0.371 0.343 0.333
Finland 0.469 0.04538 0.469 0.469 0.469 0.448 0.407 0.365 0.324
France 0.469 0.04538 0.469 0.469 0.469 0.448 0.407 0.365 0.324
Italy 0.469 0.04538 0.469 0.469 0.469 0.448 0.407 0.365 0.324
Japan (Lunar) 0.449 0.04538 0.449 0.449 0.449 0.397 0.346 0.294 0.243
Korea 0.449 0.04538 0.449 0.449 0.449 0.397 0.346 0.294 0.243
Middle East 0.434 0.04538 0.434 0.434 0.434 0.418 0.385 0.353 0.321
Philippines 0.448 0.04538 0.449 0.447 0.445 0.404 0.363 0.332 0.301
Spain 0.469 0.04538 0.469 0.469 0.469 0.448 0.407 0.365 0.324
Male reference values for Radius 33% Shaft BMD

Asia 0.960 0.10025 0.960 0.960 0.937 0.892 0.847 0.802 0.757
USA/N. Europe 1.002 0.10025 1.002 1.002 1.002 0.982 0.942 0.902 0.862
China 0.960 0.10025 0.960 0.960 0.937 0.892 0.847 0.802 0.757
Finland 1.002 0.10025 1.002 1.002 1.002 0.982 0.942 0.902 0.862
France 1.002 0.10025 1.002 1.002 1.002 0.982 0.942 0.902 0.862
Italy 1.002 0.10025 1.002 1.002 1.002 0.982 0.942 0.902 0.862
Japan (Lunar) 0.960 0.10025 0.960 0.960 0.937 0.892 0.847 0.802 0.757
Korea 0.960 0.10025 0.960 0.960 0.937 0.892 0.847 0.802 0.757
Middle East 0.945 0.10025 0.945 0.945 0.945 0.933 0.908 0.871 0.833
Spain 1.002 0.10025 1.002 1.002 1.002 0.982 0.942 0.902 0.862
Male reference data for Radius Total BMD

Asia 0.733 0.06906 0.733 0.733 0.715 0.680 0.646 0.615 0.585
USA/N. Europe 0.762 0.06906 0.762 0.762 0.762 0.749 0.721 0.694 0.667
China 0.733 0.06906 0.733 0.733 0.715 0.680 0.646 0.615 0.585
Finland 0.762 0.06906 0.762 0.762 0.762 0.749 0.721 0.694 0.667
France 0.762 0.06906 0.762 0.762 0.762 0.749 0.721 0.694 0.667
Italy 0.762 0.06906 0.762 0.762 0.762 0.749 0.721 0.694 0.667
Japan (Lunar) 0.733 0.06906 0.733 0.733 0.715 0.680 0.646 0.615 0.585
Korea 0.733 0.06906 0.733 0.733 0.715 0.680 0.646 0.615 0.585
Middle East 0.719 0.06906 0.719 0.719 0.719 0.710 0.693 0.668 0.642
Spain 0.762 0.06906 0.762 0.762 0.762 0.749 0.721 0.694 0.667
Male reference data for Radius Ultradistal BMD

Asia 0.505 0.05125 0.505 0.505 0.490 0.460 0.430 0.408 0.386
USA/N. Europe 0.5275 0.05125 0.528 0.528 0.528 0.518 0.498 0.478 0.458
China 0.505 0.05125 0.505 0.505 0.490 0.460 0.430 0.408 0.386
Finland 0.5275 0.05125 0.528 0.528 0.528 0.518 0.498 0.478 0.458
France 0.5275 0.05125 0.528 0.528 0.528 0.518 0.498 0.478 0.458
Italy 0.5275 0.05125 0.528 0.528 0.528 0.518 0.498 0.478 0.458
Japan (Lunar) 0.505 0.05125 0.505 0.505 0.490 0.460 0.430 0.408 0.386
Korea 0.505 0.05125 0.505 0.505 0.490 0.460 0.430 0.408 0.386
Middle East 0.4975 0.05125 0.497 0.497 0.497 0.491 0.479 0.460 0.441
Spain 0.5275 0.05125 0.5275 0.528 0.528 0.518 0.498 0.478 0.458
Reference Values for Lateral Spine

Female reference values for Lateral Spine L2-L3
Asia 0.660 0.12 0.660 0.660 0.620 0.540 0.460 0.430 0.400
USA/N. Europe 0.780 0.12 0.790 0.770 0.715 0.625 0.535 0.495 0.455
China 0.660 0.12 0.660 0.660 0.620 0.540 0.460 0.430 0.400
Finland 0.780 0.12 0.790 0.770 0.715 0.625 0.535 0.495 0.455
France 0.68 0.12 0.680 0.680 0.640 0.560 0.480 0.450 0.420
Italy 0.780 0.12 0.790 0.770 0.715 0.625 0.535 0.495 0.455
Japan (Lunar) 0.660 0.12 0.660 0.660 0.620 0.540 0.460 0.430 0.400
Korea 0.660 0.12 0.660 0.660 0.620 0.540 0.460 0.430 0.400
Spain 0.780 0.12 0.790 0.770 0.715 0.625 0.535 0.495 0.455
Male reference values for Lateral Spine L2-L3

USA/N. Europe 0.930 0.12 0.930 0.930 0.890 0.810 0.730 0.720 0.710
Finland 0.930 0.12 0.930 0.930 0.890 0.810 0.730 0.720 0.710
Italy 0.930 0.12 0.930 0.930 0.890 0.810 0.730 0.720 0.710
Spain 0.930 0.12 0.930 0.930 0.890 0.810 0.730 0.720 0.710
Weight Adjustment
Age-Matched comparisons can be adjusted for body weight by selecting the Weight
Adjustment default in the software. Increased weight is associated with higher BMD
values. Conversely, decreased weight is associated with lower BMD values. A weight
adjustment is applied for subjects who weigh between 25 and 100 kg and weigh
more or less than the mean weight. The mean weights are 65 kg for women and 78
kg for men in the USA (Lunar) database.
● AP Spine BMD weight adjustment per kilogram is 0.004g/cm2 (see table below).
● Femur BMD (Neck, Trochanter and Total) weight adjustment per kilogram is 0.003
g/cm2.
● The weight adjustment per kilogram for the Total Body BMD is 0.0035g/cm2.
BMD weight regression for reference females
Site Regression r SEE (g/cm2)
AP Spine BMD = 0.845 + 0.004 x Weight) 0.14 0.184
Femur Neck BMD = 0.670 + (0.003 x Weight) 0.28 0.134
Femur Trochanter BMD = 0.460 + (0.003 x Weight) 0.40 0.111
Total Body BMD = 0.886 + (0.0035 x Weight) 0.47 0.083
Lateral Spine Morphometry Reference Values

enCORE software allows comparison with reference vertebral height values for
ambulatory White male and female subjects from the general population. Variations
within normal limits of nutrition and physical activity have not been demonstrated
to have a significant influence on reference values, but stature does have some
influence.52 Skeletal morphometry data among populations can vary if there are
stature differences.
GE Healthcare vertebral morphometry is based on careful evaluation of the expected
vertebral heights of the spine from T4 to L4. Research has shown that vertebral
heights are related to each other in a highly predictable and constant manner.
Minne95 used this constant relationship to calculate expected vertebral heights based
on a comparison of the height of a person’s T4 vertebra to a reference T4 height. T4
was chosen in part because this vertebra seldom fractures. By comparing expected
heights with actual heights, indices can be calculated that quantify the extent of
vertebral deformity as compared with reference values.GE Healthcare has taken a
similar approach for determining expected normal vertebral heights, but uses the
height of the L2-L4 vertebrae rather than T4 to calculate expected vertebral heights.
T4 is small and often difficult to visualize and measure in a morphometry image of the
lateral spine.
The relationship of T4-L1 vertebrae heights relative to the L2-L4 height, obtained from
published studies, was used to ascertain a correction factor for each vertebral level
relative to the mean height for the L2-L4 sequence95-103. In other words, if a patient’s
L2-L4 Anterior Height is 95% of expected, then his vertebral Anterior Heights for other
vertebrae are compared to 95% of the reference height at each vertebral level. The
tables below show the Lunar reference heights and ratios for White women and men
for each vertebra (n=~3900). If any of the patient’s L2-L4 vertebral heights is less
than 80% of reference values, the vertebra is excluded and an indication is given
in the footnotes for the image.
Mean Female Morphometry reference values (mm)
Vertebra Anterior Ht Middle Ht Posterior Ht AP Ratio MP Ratio
T4 16.69 16.07 17.83 0.94 0.90
T5 16.93 16.56 18.27 0.93 0.91
T6 17.00 16.96 18.88 0.90 0.90
T7 17.14 17.30 19.22 0.89 0.90
T8 17.68 17.73 19.58 0.90 0.91
T9 18.60 18.44 19.97 0.93 0.92
T10 19.99 19.54 21.17 0.94 0.92
T11 21.19 20.91 22.86 0.93 0.91
T12 23.12 22.51 24.66 0.94 0.91
L1 24.72 24.11 26.05 0.95 0.93
L2 26.28 24.75 26.64 0.99 0.93
L3 27.11 25.35 26.80 1.01 0.95
L4 27.33 25.62 26.08 1.05 0.98
L5 28.20 24.95 24.32 1.16 1.03
Mean Male Morphometry Reference values (mm)
T4 17.39 17.07 18.28 0.95 0.93
T5 17.80 17.44 18.77 0.95 0.93
T6 17.85 17.78 19.35 0.92 0.92
T7 17.96 18.18 19.70 0.91 0.92
T8 18.51 18.64 20.28 0.91 0.92
T9 19.30 19.48 20.85 0.93 0.93
T10 20.71 20.68 22.11 0.94 0.94
T11 21.63 21.66 23.52 0.92 0.92
T12 22.81 23.05 24.89 0.92 0.93
L1 23.89 24.32 26.12 0.92 0.93
L2 25.37 24.62 26.63 0.95 0.93
L3 26.35 25.35 26.84 0.98 0.94
L4 26.48 25.51 26.36 1.00 0.97
L5 26.97 25.12 24.15 1.12 1.04
The standard deviation (SD) in vertebral heights among individuals is approximately

8% while the SD of the antero-posterior (AP) and middle-posterior (MP) ratios is
approximately 0.065 or 6.5%. These SDs are used to express the measurement results
at each vertebral level as a Z-score. Z-scores can be plotted for each vertebral level to
look for deviant vertebral heights and ratios.
This figure shows a lateral spine with a wedge fracture at T11.
Lateral spine image with wedge fracture at T11
This figure shows the Table of Z-scores with an AP Ratio Z-score of –4.8 for T11, well
beyond the Z-score threshold of –3 that the program highlights as a deformity or
fracture.
Morphometry table showing severe wedge at T11
Hip Axis Length

Various measures of hip geometry including Hip Axis Length (HAL) have been shown to
predict hip fracture independently of age and BMD. HAL is defined as the length along
the femoral neck axis from the base of the greater trochanter through the femoral
neck to the inner pelvic brim104-108 A recent retrospective study demonstrated a
significant relationship between HAL and hip fracture risk, measured with a fan-beam
densitometer (Lunar Prodigy).109 Odds ratios derived from multiple logistic regression
models showed that fracture risk increased 60% for each standard deviation (6 mm)
increase in HAL, consistent with previous results109 Likewise, significant increases in
fracture risk were related to decreased BMD at all femoral measurement sites.
Dual femur image showing HAL and femoral measurement sites
Scans of the proximal femur of 5435 women age 20-96 years (mean age 64.5; SD
11.4 yrs) were analyzed with Lunar Prodigy. The mean (SD) of HAL was 104.4 (5.86)
mm. The measured value for a patient was compared to mean HAL adjusted for
the patient’s height and weight.
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Pediatric Reference Data
D
Bone Mineral Density (BMD)
The bone mineral density (BMD) value gives the area density in g/cm2 for a selected
region. enCORE software plots a patient’s BMD versus age on the Reference graph.
The figure below shows an 8.5-year-old female patient with a spine BMD value of
0.667 g/cm2. Numerical divisions on the right side of the graph correspond to intervals
of one standard deviation (SD) above and below the age-matched regression line that
spans the width of the graph from age 5 to age 20 years.
Female reference graph with Age-Matched regression bar for 8.5-year-old subject
%Age-Matched
The %Age-Matched value compares the subject’s BMD with the average BMD of a
reference group of the same age and sex, and, optionally, ethnicity. This Age-Matched
comparison is displayed as the regression bar (the light green area) on the Reference
graph shown in Bone Mineral Density (BMD) (371). The Age-Matched comparison is
used to determine if the patient deviates from the reference pattern for the patient’s
age, sex, and, optionally, ethnicity. The line in the middle of the bar marks the expected
BMD value at each age. The areas above and below the centerline indicate one SD
above and below the mean BMD for any age.
The graph shows regression bars that indicate an expected gradual increase in
lumbar spine BMD until age 9, followed by a more rapid gain in BMD until age 16,
with no gain thereafter. The program also calculates the patient’s Age-Matched
Z-score. The Z-score is the number of SDs the patient’s BMD is above or below the
Age-Matched mean value. The subject’s BMD plotted in Bone Mineral Density (BMD)
(371) has a Z-score of –0.3, because the BMD value of 0.667 g/cm2 is 0.3 SDs below
the Age-Matched mean value.
The figure below shows a 12-year-old subject who has the same BMD (0.667) as the
8.5-year-old female shown in Bone Mineral Density (BMD) (371). Unlike the 8.5-year-old
patient who is within the Age-Matched regression bar, and thus has normal BMD for
her age, the 12.5-year-old subject is 2.4 SDs (Z-score or –2.4) below her age-matched
value.
Female Reference Graph with Age-Matched regression (12-year-old subject)
%Age-Matched Ethnicity Adjustment

The Ethnicity adjustment lets you factor ethnic origin (black, white, Asian, or Hispanic)
into the final Age-Matched comparison. Reference values for black populations are
typically 8-12% greater than those for white populations.13-22 The software shifts
the regression bar up if the reference population values are greater than those for
white populations, and down if less than white populations. The Ethnicity adjustment
within a reference population should not be confused with specific, nationality-based
reference data (e.g., China, USA).
%Age-Matched Nationality Reference Database

enCORE software allows the use of nationality-based reference data when available.
The selected nationality affects the location and shape of the age-matched regression
bar. For example, if you choose the Chinese reference data for the total body, the
regression bar will be lower than the USA white regression bar. Differences reflect the
smaller body size in the average Chinese child compared to U.S. children.
Reference Graph: Female and Male

The figures above in are female reference graphs. The male reference graph below
is based on the same principles, but has a different Age-Matched regression bar.
Compare the graph above (female AP spine) with the figure below (male AP spine) to
see the differences. Notice that the Young Adult BMD at age 20 is 1.22 for males
compared with 1.18 for females, and the male regression bar shows an increase in
slope at age 12, instead of age 9 as in females.
Male reference graph for spine (L1-L4) BMD
Reference Graphs: Other Sites

The figures above show reference graphs for L1-L4 region of AP spine. The reference
graphs for other sites use the same principles as the AP spine, but use different
Age-Matched regression bars. For example, results of a dual femur scan for an
8.5-year-old white female are shown in the figure below.
Female reference graph for DualFemur Total BMD
Bone Mineral Density Reference Populations

Lunar BMD reference data are based on ambulatory subjects from the general
population who were free from chronic diseases affecting bone and who were not
taking medications which influence bone (e.g., corticosteroids, anticonvulsants,
thyroxin).
Reference values from a number of white populations have been shown to be virtually
identical (e.g. U.S., Australia, Spain, The Netherlands)1-7 Race can have an influence on
BMD. For example, BMD in black subjects is about 5-12% more dense than in white
subjects. People of Asian descent have somewhat lower BMD than black or Caucasian
subjects, a finding that is at least partly associated with smaller body size.
Comparison to Age-Matched
Bone mass and density increase with age in males and female children. Data from
the USA (Lunar) and Bone Mineral Density in Childhood Study (BMDCS) reference
populations are plotted in the figures below and listed in the tables in Age Adjustment
(380)1-8. USA (Lunar) total body reference values include BMD for subjects with (Total
Body) and without the head (Total Body Less Head). Total Body Less Head reference
data are preferred by some researchers because the head makes up such a large
proportion of the total body BMD in children [Xu 2007].
Male and female USA (Lunar) reference values for spine L1-L4
Male and female USA (Lunar) reference values for femur neck and femur total BMD
Male and female USA (Lunar) reference values for total body and total body less head BMD
White and black male and female USA (BMDCS) spine L1-L4 reference values
White and black male and female USA (BMDCS) femur neck reference values
White and black male and female USA (BMDCS) total femur reference values
White and black male and female USA (BMDCS) total body reference values
White and black male and female USA (BMDCS) total body BMC reference values
Reference Population Database

Lunar USA/Northern European reference values are supported by a large database
from studies of a number of the reference populations.1-8 These studies were
conducted at university medical centers and clinics in the U.S., Australia, and Northern
Europe. The table below lists the number of subjects in the reference populations for
each measurement site.
Number of male and female subjects in the Lunar reference population
Site Femur Femur Spine Spine Total Total Body
Girls Boys Girls Boys Body Boys
Girls
Argentina 17 21
Australia 31 23 111 117 126 128
Finland 44 40
Germany 175 143 112 81 116 82
Poland 157 158 160 168
Russia 9 8
Spain 172 34 558 439 423 149
Sweden 12 12 35 13 36
Netherlands 21 343 265 343 261
USA 17 420 255 354 259
Total 407 221 1787 1390 1544 1091
Age Adjustment
Age-Matched comparisons use age regressions to calculate an expected BMD. The
subject’s BMD is compared with the expected BMD for a person of the same age
and gender in the reference population.
The tables below list female and male BMD or BMC and SD reference values at 1-year
intervals for AP Spine (L1-L4), Femur Neck, Total Femur, Total Body BMD, Total Body
BMD Less Head, and Total Body BMC.
Female reference values for Spine L1-L4 BMD and SD
USA/N. BMDCS BMDCS
Europe White Black
5 yr 0.624
0.064
6 yr 0.644
0.072
7 yr 0.664 0.629 0.669
0.080 0.072 0.076
8 yr 0.684 0.657 0.705
0.087 0.074 0.076
USA/N. BMDCS BMDCS

Europe White Black
9 yr 0.704 0.685 0.741
0.095 0.082 0.081
10 yr 0.772 0.713 0.777
0.102 0.093 0.089
11 yr 0.840 0.795 0.867
0.108 0.105 0.099
12 yr 0.908 0.877 0.957
0.114 0.116 0.110
13 yr 0.976 0.959 1.047
0.119 0.125 0.121
14 yr 1.044 1.041 1.137
0.123 0.129 0.131
15 yr 1.112 1.123 1.173
0.126 0.125 0.138
16 yr 1.180 1.143 1.209
0.127 0.113 0.141
17 yr 1.180
0.128
18 yr 1.180
0.127
19 yr 1.180
0.124
Male reference values for Spine L1-L4 BMD and SD

USA/N. BMDCS BMDCS
Europe White Black
5 yr 0.606
0.074
6 yr 0.633
0.076
7 yr 0.660 0.633 0.663
0.080 0.069 0.072
8 yr 0.687 0.657 0.690
0.086 0.069 0.073
9 yr 0.714 0.681 0.717
0.093 0.071 0.077
10 yr 0.741 0.705 0.744
0.101 0.076 0.085
USA/N. BMDCS BMDCS

Europe White Black
11 yr 0.768 0.729 0.771
0.110 0.083 0.094
12 yr 0.795 0.753 0.798
0.118 0.091 0.105
13 yr 0.880 0.843 0.893
0.125 0.101 0.116
14 yr 0.965 0.933 0.988
0.132 0.112 0.127
15 yr 1.050 1.023 1.083
0.137 0.123 0.136
16 yr 1.135 1.095 1.130
0.139 0.135 0.142
17 yr 1.220 1.167 1.177
0.140 0.147 0.146
18 yr 1.220
0.137
19 yr 1.220
0.130
Female reference values for Femur Neck BMD and SD

USA/N. Europe BMDCS White BMDCS Black
5 yr 0.640
0.061
6 yr 0.660
0.062
7 yr 0.680 0.698 0.752
0.067 0.063 0.074
8 yr 0.700 0.725 0.787
0.074 0.065 0.079
9 yr 0.720 0.752 0.822
0.083 0.071 0.088
10 yr 0.776 0.779 0.877
0.092 0.080 0.100
11 yr 0.832 0.838 0.932
0.103 0.090 0.113
12 yr 0.888 0.897 0.987
0.113 0.101 0.127
13 yr 0.944 0.956 1.042
0.122 0.112 0.140
USA/N. Europe BMDCS White BMDCS Black

14 yr 1.000 1.015 1.097
0.130 0.122 0.151
15 yr 1.000 1.037 1.112
0.135 0.131 0.159
16 yr 1.000 1.059 1.127
0.139 0.138 0.162
17 yr 1.000
0.139
18 yr 1.000
0.135
19 yr 1.000
0.126
Female reference values for Total Femur BMD and SD

USA/N. Europe BMDCS White BMDCS
Black
5 yr 0.630
0.059
6 yr 0.645
0.060
7 yr 0.660 0.638 0.705
0.064 0.061 0.068
8 yr 0.675 0.666 0.733
0.070 0.064 0.071
9 yr 0.690 0.694 0.761
0.078 0.071 0.077
10 yr 0.754 0.722 0.789
0.087 0.082 0.086
11 yr 0.818 0.788 0.863
0.097 0.095 0.098
12 yr 0.882 0.854 0.937
0.107 0.107 0.110
13 yr 0.946 0.920 1.011
0.116 0.118 0.122
14 yr 1.010 0.986 1.032
0.124 0.125 0.132
15 yr 1.010 1.007 1.053
0.130 0.126 0.141
16 yr 1.010 1.028 1.074
0.134 0.121 0.146

Black
17 yr 1.010
0.134
18 yr 1.010
0.131
19 yr 1.010
0.124
Male reference values for Femur Neck BMD and SD

Black
5 yr 0.678
0.074
6 yr 0.704
0.075
7 yr 0.730 0.753 0.812
0.078 0.075 0.089
8 yr 0.756 0.782 0.849
0.082 0.077 0.094
9 yr 0.782 0.811 0.886
0.088 0.080 0.101
10 yr 0.808 0.840 0.923
0.094 0.084 0.108
11 yr 0.834 0.869 0.960
0.100 0.089 0.116
12 yr 0.860 0.898 0.997
0.107 0.096 0.124
13 yr 0.910 0.927 1.054
0.113 0.104 0.134
14 yr 0.960 1.001 1.111
0.119 0.115 0.143
15 yr 1.010 1.075 1.168
0.124 0.128 0.154
16 yr 1.060 1.126 1.208
0.128 0.143 0.165
17 yr 1.110 1.177 1.248
0.131 0.162 0.177

Black
18 yr 1.110
0.132
19 yr 1.110
0.130
Male reference values for Total Femur BMD and SD

Black
5 yr 0.649
0.091
6 yr 0.677
0.088
7 yr 0.705 0.694 0.761
0.087 0.076 0.079
8 yr 0.733 0.722 0.794
0.088 0.074 0.080
9 yr 0.761 0.750 0.827
0.092 0.075 0.084
10 yr 0.789 0.778 0.860
0.098 0.079 0.093
11 yr 0.817 0.806 0.893
0.104 0.085 0.104
12 yr 0.845 0.834 0.926
0.111 0.094 0.116
13 yr 0.900 0.904 0.993
0.118 0.103 0.129
14 yr 0.955 0.974 1.060
0.125 0.114 0.142
15 yr 1.010 1.044 1.127
0.131 0.125 0.152
16 yr 1.065 1.114 1.170
0.135 0.137 0.160
17 yr 1.120 1.154 1.213
0.137 0.148 0.165
18 yr 1.120
0.137
19 yr 1.120
0.134
Female reference values for Total Body BMD and SD– Basic Analysis (Prodigy, DPX-NT)
USA/N. Europe BMDCS White BMDCS Black China/Asia
5 yr 0.793 0.760
0.022 0.037
6 yr 0.806 0.772
0.036 0.037
7 yr 0.819 0.772 0.822 0.784
0.049 0.048 0.044 0.039
8 yr 0.832 0.805 0.854 0.796
0.059 0.048 0.045 0.043
9 yr 0.845 0.838 0.886 0.808
0.068 0.051 0.048 0.048
10 yr 0.885 0.871 0.918 0.820
0.075 0.055 0.053 0.054
11 yr 0.925 0.904 0.967 0.860
0.081 0.060 0.059 0.061
12 yr 0.965 0.960 1.016 0.900
0.084 0.065 0.066 0.068
13 yr 1.005 1.016 1.065 0.940
0.086 0.069 0.073 0.075
14 yr 1.045 1.072 1.114 0.980
0.086 0.071 0.079 0.080
15 yr 1.085 1.096 1.134 1.020
0.084 0.072 0.086 0.085
16 yr 1.125 1.120 1.154 1.060
0.081 0.069 0.091 0.087
17 yr 1.125 1.060
0.076 0.087
18 yr 1.125 1.060
0.070 0.084
19 yr 1.125 1.060
0.063 0.079
Female reference values for Total Body BMD and SD– Enhanced Analysis (Prodigy, iDXA)
5 yr 0.662 0.620
0.028 0.047
6 yr 0.678 0.635
0.045 0.047
7 yr 0.695 0.635 0.698 0.650
0.062 0.061 0.055 0.049

8 yr 0.711 0.677 0.739 0.665
0.074 0.061 0.057 0.054
9 yr 0.727 0.718 0.779 0.681
0.086 0.064 0.061 0.061
10 yr 0.778 0.760 0.819 0.696
0.095 0.069 0.067 0.068
11 yr 0.828 0.802 0.881 0.746
0.102 0.076 0.074 0.077
12 yr 0.879 0.872 0.943 0.797
0.106 0.082 0.083 0.086
13 yr 0.929 0.943 1.005 0.847
0.108 0.087 0.092 0.095
14 yr 0.980 1.014 1.067 0.898
0.108 0.090 0.100 0.101
15 yr 1.030 1.044 1.092 0.948
0.106 0.091 0.108 0.107
16 yr 1.080 1.074 1.117 0.998
0.102 0.087 0.115 0.110
17 yr 1.080 0.998
0.096 0.110
18 yr 1.080 0.998
0.088 0.106
19 yr 1.080 0.998
0.079 0.100
Female reference values for Total Body Less Head BMD and SD – Basic Analysis (Prodigy, DPX-NT)
USA/N. Europe China/ Asia
5 yr 0.622 0.538
0.044 0.037
6 yr 0.648 0.570
0.052 0.037
7 yr 0.674 0.602
0.059 0.040
8 yr 0.700 0.634
0.066 0.045
9 yr 0.726 0.666
0.072 0.050
10 yr 0.767 0.698
0.077 0.057

11 yr 0.808 0.747
0.082 0.064
12 yr 0.849 0.796
0.085 0.071
13 yr 0.890 0.845
0.087 0.077
14 yr 0.931 0.894
0.088 0.083
15 yr 0.972 0.943
0.087 0.087
16 yr 1.013 0.943
0.085 0.089
17 yr 1.013 0.943
0.081 0.090
18 yr 1.013 0.943
0.076 0.087
19 yr 1.013 0.943
0.069 0.082
Female reference values for Total Body Less Head BMD and SD – Enhanced
Analysis (Prodigy, iDXA)
USA/N.
Europe
5 yr 0.498
0.048
6 yr 0.546
0.052
7 yr 0.595
0.058
8 yr 0.643
0.064
9 yr 0.692
0.071
10 yr 0.740
0.079
11 yr 0.789
0.088
12 yr 0.837
0.098
USA/N.
Europe
13 yr 0.886
0.109
14 yr 0.934
0.120
15 yr 0.953
0.106
16 yr 0.958
0.095
17 yr 0.963
0.090
18 yr 0.968
0.089
19 yr 0.973
0.088
Female reference values for Total Body BMC and SD – Basic Analysis (Prodigy, DPX-NT)
BMDCS White BMDCS Black
5 yr
6 yr
7 yr 811 880
126 119
8 yr 913 1020
125 133
9 yr 1015 1160
148 157
10 yr 1117 1300
188 189
11 yr 1376 1560
236 225
12 yr 1635 1820
284 264
13 yr 1894 2080
324 302
14 yr 2153 2340
347 337
15 yr 2273 2439
345 366
16 yr 2393 2538
310 385

17 yr
18 yr
19 yr
Male reference values for Total Body BMD and SD – Basic Analysis (Prodigy, DPX-NT)
USA/N. Europe BMDCS White BMDCS China/ Asia
Black
5 yr 0.780 0.761
0.042 0.046
6 yr 0.800 0.775
0.043 0.045
7 yr 0.820 0.797 0.853 0.789
0.046 0.047 0.051 0.046
8 yr 0.840 0.827 0.884 0.803
0.050 0.047 0.048 0.049
9 yr 0.860 0.857 0.915 0.817
0.055 0.048 0.048 0.053
10 yr 0.880 0.887 0.946 0.832
0.061 0.049 0.052 0.058
11 yr 0.900 0.917 0.977 0.846
0.067 0.051 0.057 0.064
12 yr 0.920 0.947 1.008 0.860
0.073 0.054 0.065 0.069
13 yr 0.970 0.977 1.039 0.906
0.079 0.058 0.073 0.075
14 yr 1.020 1.029 1.091 0.952
0.084 0.063 0.080 0.079
15 yr 1.070 1.081 1.143 0.998
0.089 0.070 0.087 0.083
16 yr 1.120 1.133 1.195 1.044
0.093 0.079 0.091 0.086
17 yr 1.170 1.185 1.231 1.090
0.096 0.089 0.092 0.086
18 yr 1.220 1.136
0.097 0.085
19 yr 1.220 1.136
0.097 0.082
Male reference values for Total Body BMD and SD – Enhanced Analysis (Prodigy, iDXA)
USA/N. Europe BMDCS White BMDCS Black China/ Asia
5 yr 0.645 0.621
0.053 0.058
6 yr 0.671 0.639
0.054 0.057
7 yr 0.696 0.667 0.737 0.657
0.058 0.059 0.064 0.058
8 yr 0.721 0.705 0.776 0.674
0.063 0.059 0.061 0.062
9 yr 0.746 0.742 0.816 0.692
0.069 0.061 0.061 0.067
10 yr 0.771 0.780 0.855 0.711
0.077 0.062 0.066 0.073
11 yr 0.797 0.818 0.894 0.729
0.085 0.064 0.072 0.081
12 yr 0.822 0.856 0.933 0.746
0.092 0.068 0.082 0.087
13 yr 0.885 0.894 0.972 0.804
0.100 0.073 0.092 0.095
14 yr 0.948 0.959 1.038 0.862
0.106 0.079 0.101 0.100
15 yr 1.011 1.025 1.103 0.920
0.112 0.088 0.110 0.105
16 yr 1.074 1.091 1.169 0.978
0.117 0.100 0.115 0.108
17 yr 1.137 1.156 1.214 1.036
0.121 0.112 0.116 0.108
18 yr 1.200 1.094
0.122 0.107
19 yr 1.200 1.094
0.122 0.103
Male reference values for Total Body Less Head BMD and SD – Basic Analysis (Prodigy, DPX-NT)
5 yr 0.600 0.547
0.043 0.037
6 yr 0.631 0.580
0.045 0.035
7 yr 0.662 0.613
0.048 0.036

8 yr 0.693 0.646
0.053 0.039
9 yr 0.724 0.679
0.059 0.043
10 yr 0.755 0.712
0.066 0.049
11 yr 0.786 0.745
0.072 0.055
12 yr 0.817 0.778
0.079 0.062
13 yr 0.868 0.830
0.085 0.069
14 yr 0.919 0.882
0.091 0.076
15 yr 0.970 0.934
0.095 0.082
16 yr 1.021 0.986
0.098 0.088
17 yr 1.072 1.038
0.100 0.092
18 yr 1.072 1.090
0.099 0.095
19 yr 1.072 1.090
0.096 0.096
Male reference values for Total Body Less Head BMD and SD – Enhanced Analysis (Prodigy, iDXA)
USA/N. Europe
5 yr 0.482
0.046
6 yr 0.530
0.054
7 yr 0.578
0.068
8 yr 0.626
0.071
9 yr 0.674
0.079
10 yr 0.722
0.088
USA/N. Europe
11 yr 0.769
0.096
12 yr 0.817
0.104
13 yr 0.865
0.113
14 yr 0.913
0.121
15 yr 0.961
0.130
16 yr 1.009
0.138
17 yr 1.038
0.143
18 yr 1.038
0.143
19 yr 1.038
0.143
Male reference values for Total Body BMC and SD – Basic Analysis (Prodigy, DPX-NT)
5 yr
6 yr
7 yr 849 929
136 126
8 yr 974 1083
125 118
9 yr 1099 1237
131 138
10 yr 1224 1391
152 178
11 yr 1349 1545
184 233
12 yr 1474 1699
225 295
13 yr 1793 2035
273 358
14 yr 2112 2371
325 414

15 yr 2431 2647
378 458
16 yr 2750 2923
430 482
17 yr 3050 3199
479 479
18 yr
19 yr
Growth Indices
Pediatric growth reference values are available for the following relationships:
● height for age
● bone area for height
● BMC for bone area
● BMC for lean mass
● lean mass for height
The height for age reference values come from regression fits to the LMS
parameters used to create the Center for Disease Control’s year 2000 growth charts
[http://www.gov/growthcharts], which were mostly constructed using National Health
and Nutrition Examination Survey (NHANES) data. The specifications described in this
section apply to the following Reference Population selections: USA (Lunar), Australia
(Lunar), Germany, Brazil, England, Australia (Combined Geelong/Lunar), Finland, Italy,
Spain and USA (Combined NHANES/Lunar).
Reference values for bone area for height, BMC for bone area, BMC for lean mass, and
lean mass for height are based on DXA total body measurements from over 1000
female and over 600 male pediatric subjects ages 5 through 19 made at 8 locations in
the USA, Europe, and Australia. These indices have been shown previously to be useful
in pediatric bone assessment.10 -12 Data were fit to LMS models which describe the
population distribution at each value of the independent variable in terms of three
parameters: L (the Box-Cox power parameter λ) which specifies the skew, M which
specifies the median (= mean of the transformed distribution), and S which specifies
the standard deviation. Initial parameter fits used the penalized likelihood method
of Cole and Green13. The L parameter was then used to transform the data and
equations describing both M and (using Altman’s method13) S were iteratively fit by
regression. Limits were set so that reference values would not be applied to patients
who fall outside of the range of the subjects measured. Tables of selected centiles
of the reference values follow.
Basic Analysis
Basic Analysis is available on Prodigy and DPX-NT.
Female Pediatric Total Body Bone Area for Height Centiles – Basic Analysis
Bone Area (cm²) for Centile
Height 1 5 20 50 80 95 99
(cm)
90 427.1 452.9 485.3 521.8 561.0 601.1 637.4
95 476.2 505.0 541.1 581.7 625.5 670.2 710.7
100 529.4 561.4 601.6 646.8 695.4 745.1 790.2
105 587.1 622.5 667.1 717.2 771.1 826.3 876.2
110 649.4 688.6 737.9 793.4 853.0 914.0 969.2
115 716.7 760.0 814.4 875.6 941.4 1008.8 1069.7
120 789.3 837.0 896.9 964.3 1036.8 1111.0 1178.1
125 867.6 920.0 985.9 1059.9 1139.6 1221.1 1294.9
130 951.8 1009.3 1081.6 1162.9 1250.2 1339.7 1420.6
135 1042.4 1105.4 1184.5 1273.5 1369.2 1467.2 1555.8
140 1139.7 1208.6 1295.1 1392.4 1497.0 1604.1 1701.0
145 1244.1 1319.3 1413.7 1519.9 1634.1 1751.1 1856.8
150 1356.0 1438.0 1540.9 1656.7 1781.1 1908.6 2023.9
155 1475.9 1565.1 1677.1 1803.1 1938.6 2077.4 2202.9
160 1604.3 1701.2 1823.0 1959.9 2107.1 2258.0 2394.4
165 1741.5 1846.7 1978.9 2127.6 2287.4 2451.1 2599.2
170 1888.1 2002.2 2145.5 2306.7 2480.0 2657.5 2818.1
175 2044.7 2168.2 2323.4 2498.0 2685.6 2877.9 3051.7
180 2211.7 2345.4 2513.2 2702.1 2905.0 3113.0 3301.0
Male Pediatric Total Body Bone Area for Height Centiles – Basic Analysis
Height 1 5 20 50 80 95 99
(cm)
80 334.3 352.5 375.1 400.5 427.5 455.0 479.7
85 380.5 401.2 427.0 455.8 486.6 517.9 546.1
90 430.4 453.8 483.0 515.6 550.4 585.8 617.7
95 484.1 510.4 543.2 579.9 619.1 658.9 694.7
100 541.7 571.1 607.9 648.9 692.8 737.3 777.4
105 603.4 636.2 677.1 722.8 771.6 821.3 865.9
110 669.2 705.6 751.0 801.7 855.8 910.9 960.4
115 739.4 779.6 829.8 885.8 945.6 1006.4 1061.1
120 814.1 858.3 913.6 975.2 1041.1 1108.1 1168.3

125 893.4 941.9 1002.5 1070.2 1142.5 1216.0 1282.0
130 977.4 1030.5 1096.8 1170.9 1249.9 1330.4 1402.6
135 1066.4 1124.3 1196.6 1277.4 1363.7 1451.4 1530.3
140 1160.3 1223.4 1302.1 1390.0 1483.9 1579.3 1665.1
145 1259.5 1328.0 1413.4 1508.8 1610.7 1714.3 1807.5
150 1364.1 1438.2 1530.7 1634.1 1744.4 1856.6 1957.5
155 1474.1 1554.2 1654.2 1765.9 1885.1 2006.4 2115.4
160 1589.9 1676.2 1784.1 1904.5 2033.1 2163.9 2281.5
165 1711.4 1804.4 1920.5 2050.1 2188.5 2329.4 2455.9
170 1838.9 1938.8 2063.6 2202.9 2351.6 2502.9 2638.9
175 1972.6 2079.8 2213.6 2363.0 2522.6 2684.9 2830.7
180 2112.6 2227.4 2370.7 2530.7 2701.6 2875.4 3031.6
185 2259.0 2381.8 2535.0 2706.2 2888.9 3074.8 3241.8
190 2412.2 2543.2 2706.8 2889.6 3084.7 3283.1 3461.5
Female Pediatric Total Body BMC for Bone Area Centiles – Basic Analysis
BMC (g) for Centile
Bone Area 1 5 20 50 80 95 99
(cm²)
500 327.6 338.3 351.2 365.0 379.1 392.9 404.8
650 433.3 448.0 465.8 484.9 504.5 523.6 540.1
800 548.9 568.4 591.9 617.2 643.0 668.3 690.3
950 674.5 699.4 729.5 761.8 794.9 827.4 855.5
1100 809.9 840.9 878.4 918.8 960.3 1000.8 1036.1
1250 954.9 992.9 1038.8 1088.3 1139.2 1189.0 1232.3
1400 1109.6 1155.4 1210.7 1270.4 1331.7 1392.0 1444.3
1550 1273.8 1328.2 1394.0 1465.0 1538.1 1609.9 1672.4
1700 1447.4 1511.3 1588.7 1672.3 1758.4 1843.1 1916.8
1850 1630.4 1704.7 1794.8 1892.2 1992.8 2091.7 2177.8
2000 1822.5 1908.2 2012.3 2125.0 2241.3 2355.8 2455.7
2150 2023.8 2122.0 2241.3 2370.5 2504.1 2635.7 2750.6
2300 2234.2 2345.9 2481.7 2629.0 2781.4 2931.6 3062.9
2450 2453.5 2579.8 2733.5 2900.4 3073.2 3243.7 3392.8
2600 2681.8 2823.8 2996.8 3184.8 3379.7 3572.2 3740.6
2750 2918.8 3077.7 3271.6 3482.3 3701.0 3917.3 4106.6
Male Pediatric Total Body BMC for Bone Area Centiles – Basic Analysis
BMC (g) for Centile
Bone Area 1 5 20 50 80 95 99
(cm²)
500 329.7 341.3 355.3 370.2 385.6 400.6 413.6
650 433.4 449.0 467.9 488.1 508.9 529.2 546.8
800 546.5 566.7 591.1 617.3 644.2 670.5 693.4
950 669.1 694.4 725.0 757.9 791.7 824.8 853.5
1100 801.0 832.1 869.6 910.0 951.6 992.3 1027.6
1250 941.9 979.5 1024.8 1073.7 1123.9 1173.1 1215.9
1400 1091.5 1136.3 1190.5 1248.9 1309.0 1367.9 1419.2
1550 1248.9 1302.0 1366.3 1435.7 1507.1 1577.3 1638.3
1700 1413.5 1476.2 1552.1 1634.1 1718.7 1801.8 1874.2
1850 1584.9 1658.4 1747.7 1844.3 1944.0 2042.1 2127.6
2000 1762.7 1848.6 1953.1 2066.2 2183.2 2298.4 2399.0
2150 1947.3 2046.9 2168.2 2299.9 2436.2 2570.7 2688.3
2300 2138.8 2253.5 2393.4 2545.4 2703.1 2858.9 2995.3
2450 2337.4 2468.5 2628.6 2802.9 2983.9 3163.0 3320.0
2600 2543.3 2692.1 2874.0 3072.3 3278.6 3483.1 3662.4
2750 2756.2 2924.0 3129.4 3353.7 3587.4 3819.3 4022.9
2900 2976.2 3164.3 3395.0 3647.2 3910.4 4171.9 4401.7
3000 3126.6 3329.1 3577.6 3849.6 4133.7 4416.2 4664.7
Female Pediatric Total Body Lean Tissue Mass for Height Centiles – Basic Analysis
Lean Tissue Mass (g) for Centile
Height (cm) 1 5 20 50 80 95 99
80 6830 7264 7826 8483 9220 10009 10755
90 8166 8685 9357 10143 11024 11968 12860
100 9737 10356 11157 12094 13144 14270 15333
110 11593 12329 13284 14399 15650 16990 18256
120 13798 14674 15810 17138 18626 20221 21728
130 16433 17477 18830 20410 22183 24082 25877
140 19602 20847 22461 24347 26461 28727 30868
150 23441 24930 26860 29114 31643 34352 36913
160 28127 29913 32229 34934 37968 41219 44291
170 33896 36048 38839 42099 45755 49673 53376
Male Pediatric Total Body Lean Tissue Mass for Height Centiles – Basic Analysis
Height 1 5 20 50 80 95 99
(cm)
80 7064 7540 8162 8892 9717 10608 11457
90 8462 9033 9777 10652 11640 12708 13724
100 10110 10791 11680 12725 13906 15182 16396
110 12062 12875 13936 15183 16592 18113 19562
120 14388 15358 16623 18111 19791 21606 23334
130 17177 18335 19845 21621 23628 25795 27858
140 20544 21929 23735 25859 28259 30850 33317
150 24637 26298 28464 31011 33889 36997 39956
160 29654 31653 34260 37326 40790 44531 48092
170 35860 38277 41430 45137 49326 53850 58157
180 43614 46554 50388 54897 59992 65494 70732
190 53413 57014 61709 67231 73471 80209 86623
Female Pediatric Total Body BMC for Lean Tissue Mass Centiles – Basic Analysis
BMC (g) for Centile
Lean Mass 1 5 20 50 80 95 99
(g)
6500 149.1 162.4 179.6 199.6 221.9 245.4 267.3
8200 209.9 228.6 252.8 281.0 312.3 345.4 376.2
10000 279.5 304.4 336.7 374.2 415.8 459.9 500.9
20000 732.2 797.5 882.1 980.2 1089.4 1204.8 1312.3
30000 1254.8 1366.7 1511.5 1679.8 1866.8 2064.6 2248.8
40000 1820.1 1982.5 2192.6 2436.7 2707.9 2994.9 3262.1
50000 2415.5 2631.0 2909.8 3233.7 3593.7 3974.5 4329.1
Male Pediatric Total Body BMC for Lean Tissue Mass Centiles – Basic Analysis
BMC (g) for Centile
Lean Mass 1 5 20 50 80 95 99
(g)
8200 207.4 223.1 243.0 265.8 290.7 316.6 340.5
10000 278.9 299.9 326.7 357.3 390.8 425.7 457.8
20000 714.5 768.3 836.9 915.4 1001.2 1090.7 1172.8
30000 1168.3 1256.2 1368.4 1496.7 1637.1 1783.3 1917.5
40000 1618.6 1740.4 1895.8 2073.6 2268.1 2470.6 2656.6
50000 2059.5 2214.6 2412.4 2638.6 2886.0 3143.7 3380.4
BMC (g) for Centile

60000 2489.5 2676.9 2916.0 3189.4 3488.5 3800.1 4086.1
72000 2990.7 3215.9 3503.1 3831.6 4190.9 4565.2 4908.8
Enhanced Analysis
Enhanced Analysis is available on iDXA and Prodigy.
Female Pediatric Total Body Bone Area for Height Centiles – Enhanced Analysis
Height (cm) 1 5 20 50 80 95 99
100 768.0 793.8 824.9 858.0 891.8 924.6 953.0
105 841.7 870.0 904.0 940.3 977.4 1013.4 1044.4
110 916.9 947.8 984.8 1024.4 1064.7 1104.0 1137.8
115 993.6 1027.0 1067.1 1110.0 1153.7 1196.2 1232.9
120 1071.6 1107.6 1150.9 1197.1 1244.3 1290.1 1329.7
150 1563.2 1615.8 1679.0 1746.4 1815.2 1882.1 1939.8
190 2267.9 2344.2 2435.8 2533.7 2633.5 2730.5 2814.2
Male Pediatric Total Body Bone Area for Height Centiles – Enhanced Analysis
Height 1 5 20 50 80 95 99
(cm)
100 759.5 784.0 815.1 850.5 889.0 929.2 966.3
105 831.3 858.3 892.3 931.0 973.2 1017.2 1057.8
110 905.7 935.0 972.1 1014.2 1060.2 1108.1 1152.3
115 982.3 1014.1 1054.3 1100.0 1149.9 1201.9 1249.8
120 1061.1 1095.5 1138.9 1188.3 1242.2 1298.3 1350.1
150 1572.5 1623.4 1687.8 1760.9 1840.8 1924.0 2000.7
190 2322.4 2397.5 2492.6 2600.7 2718.6 2841.5 2954.9
Female Pediatric Total Body BMC for Bone Area Centiles – Enhanced Analysis
BMC (g) for Centile
Bone Area 1 5 20 50 80 95 99
(cm²)
850 492.4 508.3 527.7 548.8 570.8 592.6 611.7
860 497.8 514.0 533.9 555.5 578.1 600.4 620.0
880 508.8 525.8 546.6 569.2 592.9 616.3 636.9
900 520.0 537.8 559.5 583.3 608.0 632.6 654.3
BMC (g) for Centile

1000 579.9 602.0 629.1 658.8 689.9 721.0 748.4
1500 1000.6 1058.1 1130.2 1211.1 1297.7 1386.1 1465.9
2200 2069.0 2196.1 2355.9 2535.9 2729.6 2928.3 3108.2
Male Pediatric Total Body BMC for Bone Area Centiles – Enhanced Analysis
BMC (g) for Centile
Bone Area 1 5 20 50 80 95 99
(cm²)
850 508.4 526.8 549.3 573.9 599.6 625.2 647.8
860 513.6 532.3 555.2 580.3 606.5 632.6 655.6
880 524.1 543.5 567.2 593.3 620.5 647.6 671.6
900 534.8 554.9 579.5 606.5 634.8 663.0 687.9
1000 591.6 615.5 645.0 677.4 711.4 745.4 775.6
1500 979.8 1033.8 1101.3 1176.8 1257.4 1339.5 1413.4
2200 1851.0 1994.3 2177.6 2387.7 2618.0 2858.6 3079.9
Female Pediatric Total Body Lean Tissue Mass for Height Centiles – Enhanced
Analysis
Height (cm) 1 5 20 50 80 95 99
100 8766 9101 9522 9995 10504 11027 11502
105 9648 10052 10562 11139 11764 12412 13004
110 10602 11084 11695 12392 13152 13946 14676
115 11633 12203 12930 13764 14682 15646 16541
120 12749 13418 14278 15270 16369 17533 18620
150 21797 23392 25507 28046 30984 34240 37423
190 45233 49727 55939 63785 73406 84771 96620
Male Pediatric Total Body Lean Tissue Mass for Height Centiles – Enhanced Analysis
Height 1 5 20 50 80 95 99
(cm)
100 9198 9630 10180 10807 11494 12214 12878
105 10132 10635 11277 12014 12826 13681 14474
110 11139 11722 12469 13331 14285 15295 16239
115 12228 12899 13764 14768 15885 17073 18190
120 13405 14176 15174 16337 17639 19032 20348
150 22877 24548 26762 29421 32496 35904 39234
190 46735 51076 57018 64428 73383 83792 94463
Female Pediatric Total Body BMC for Lean Tissue Mass Centiles – Enhanced Analysis
BMC (g) for Centile
Lean 1 5 20 50 80 95 99
Mass(g)
9000 392.9 417.1 447.6 482.0 519.0 556.9 591.3
10000 439.6 466.7 500.8 539.3 580.7 623.1 661.6
15000 677.3 719.1 771.6 830.8 894.6 960.0 1019.2
20000 920.3 977.1 1048.6 1129.0 1215.7 1304.6 1385.0
25000 1167.5 1239.5 1330.2 1432.2 1542.1 1654.9 1757.0
35000 1714.9 1816.0 1942.8 2085.2 2238.0 2394.3 2535.4
45000 1996.1 2113.7 2261.3 2427.1 2605.0 2786.9 2951.1
Male Pediatric Total Body BMC for Lean Tissue Mass Centiles – Enhanced Analysis
BMC (g) for Centile
Lean Mass 1 5 20 50 80 95 99
(g)
9000 376.2 398.0 425.4 456.2 489.2 522.9 553.3
10000 419.8 444.2 474.8 509.2 546.0 583.6 617.5
15000 640.7 677.9 724.6 777.0 833.1 890.5 942.3
20000 864.7 915.0 978.0 1048.7 1124.5 1201.9 1271.8
25000 1091.2 1154.6 1234.1 1323.3 1419.0 1516.7 1604.9
35000 1528.0 1616.8 1728.1 1853.0 1987.0 2123.8 2247.3
45000 1930.2 2042.5 2183.1 2340.9 2510.1 2683.0 2839.0
References
1. Lu PW, Briody JN, Ogle GD, Morley K, Humphries IRG, Allen J, Howman-Giles R,
Sillence D, Cowell CT (1994) Bone mineral density of total body, spine, and femoral
neck in children and young adults: A cross-sectional and longitudinal study. J
2. Del Rio L, Carrascosa A, Pons F, Businve M, Yeste D, Monenech FM (1994) Bone
mineral density of the lumbar spine in white Mediterranean Spanish children and
adolescents. Changes related to age, sex, and puberty. Ped Res 35:362-366.
3. Kroger H, Kotaniemi A, Vainio P, Alhava E (1992) Bone densitometry of the spine
and femur in children by dual-energy x-ray absorptiometry. Bone Miner 17:75085.
4. Matkovic V, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, Andon MB, Smith
KT, Heaney RP (1994) Timing of peak bone mass in Caucasian females and its
implication for the prevention of osteoporosis. J Clin Invest 93:799-808.
5. Maynard LM, Guo SS, Chumlea WC, Roche AF, Wisemandle WA, Zeller CM, Towne
B, Siervogel RM (1998) Total-body and regional bone mineral content and areal
bone mineral density in children aged 8-18 y: the Fels Longitudinal Study. Am J
Clin Nutr 68:1111-1117.
6. Ponder SW, McCormick DP, Fawcett HD, Palmer JL, McKernan MG, Brouhard BH
(1990) Spinal bone mineral density in children aged 5.00 through 11.99 years.
ADJC 144:1346-1348.
7. Van der Sluis IM, de Ridder MAJ, Boot AM, Krenning EP, de Muinck Keizer-Schramer
SMP (2002) Reference data for bone density and body composition measured
with dual energy x-ray absorptiometry in white children and young adults. Arch
Dis Child 87:341-347.
8. Kalkwarf HJ, Zemel BS, Gilsanz V, Lappe JM, Horlick M, Oberfield S, Mahboubi S,
Fan B, Frecerick MM, Winer K, Shepherd JA (2007) The Bone Mineral Density in
Childhood Study: bone mineral content and density according to age, sex, and
race. J Clin Endocrinol Metabol 92(6):2087-2099.
9. Xu H, Chen J-X, Zhong T-M, Wu Q-L, Yuan Z-M, Wang J-F (2007) Normal
reference data for bone density in healthy Chinese children. J Clin Densitometry
10(3):266-275.
10. Molgaard C, Thomsen B-L, Prentice A, Cole TJ, Michaelsen KF (1997) Whole body
bone mineral content in healthy children and adolescents. Arch Dis Child 76:9-15.
11. Crabtree NJ, Kibirige MS, Fordham JN, Banks LM, Muntoni F, Chinn D, Boivin CM,
Shaw NJ (2004) The relationship between lean body mass and bone mineral
content in paediatric health and disease. Bone 35:965-972.
12. Hogler W, Briody J, Woodhead HJ, Cowell CT (2003) Importance of lean mass in
the interpretation of total body densitometry in childhood and adolescents. J
Pediatr 143:81-88.
13. Cole; TJ, Green M (1992) Smoothing reference centile curves: The LMS method and
penalized likelihood. Statistics in Medicine 11:1305-1319.
14. Altman DG (1993) Construction of age-related reference centiles using absolute
residuals. Statistics in Medicine 12:917-924. John Wiley & Sons, Ltd.
Body Composition Reference Data
E
Introduction
Body composition measurement with dual energy X-ray absorptiometry (DXA) is used
increasingly for a variety of clinical and research applications. Nutrition, exercise, and
aging have profound effects on fat and lean tissue. Body composition measurements
in general are used for a variety of health and human performance applications.
Body composition measurements provide important information for management of
patients with many conditions, including anorexia nervosa [1-8], and diseases that
cause muscle wasting, such as HIV infection (AIDS) [9-11]. Total body scans with DXA
rely on assumptions that the human body consists of bone mineral content, fat mass
and bone free lean mass. Measurements with DXA are:
● Fast, less than 10 minutes;
● Simple and non-invasive, ensuring patient cooperation;
● Low dose, equivalent to several hours of background radiation, and;
● They provide both total body and regional (trunk, arms, legs) results.
Android and Gynoid Regions of Interest

The recognition that body fat distribution is an important independent risk factor for
a variety of serious diseases has increased interest in determining who among the
overweight population are at the greatest risk for disease. Those with increased upper
body (abdominal) fat are thought to be at the greatest risk.
To aid in this measurement, android and gynoid regions of interest (ROIs) are
automatically placed and ratios are automatically calculated. The android ROI
includes the area between the pelvis cut line extending upwards to include 20% of
the distance between the pelvis and neck cut lines. The arm cut lines when in the
normal position for a total body scan defines lateral boundaries. The gynoid ROI is
positioned with the upper boundary positioned below the pelvis cut line a distance
equal to 1.5 times the height of the android region. The lower boundary is located a
distance 3.5 times the height of the android region from the pelvis cut line. Lateral
boundaries are the outer leg cut lines. The figure below shows an example of android
and gynoid positions.
Android and gynoid ROIs
Reference Populations that Support Total Body

Composition Reference Data
● Asia
● Australia (Combined Geelong/Lunar)
● Australia (Lunar)
● Brazil
● China
● England
● Finland
● Germany
● Japan
● Korea
● USA (Combined BMDCS/Lunar)
● USA (Combined NHANES/BMDCS/Lunar)
● USA (Combined NHANES/Lunar)
● USA (Lunar)
Body Composition Reference Values for Female

Percent Fat
USA/Northern Europe
Data were obtained from several sources (1910 subjects total):
● 270 subjects participating in a study of normal subjects (The Monarch Foundation,

Cincinnati, Ohio) [12]
● 169 subjects (Ohio State University) [13]
● 1471 subjects from literature [14-25]
Data were pooled and average results by decade from age 20-89 years were fitted to
a 4th order polynomial.
Results:
The equation for age-matched mean %Fat:
%Fat = 32.5956646 + (-0.604717149 x Age) + (0.0227293792 x Age2) +
(-0.000218279209 x Age3) + (0.000000459188486 x Age4).
The mean %Fat for females age 20-29 years was about 28.5% and peaked at about
38% at age 65 before gradually declining to about 35.5% at age 85 years.
The standard deviation of the reference population was set at 8%.
This data supports White patients only.
Japan/Korea
Data were obtained from literature (1006 subjects total). [29]
Average results by decade from age 20-79 years were fitted to a third order
polynomial.
Results:
% Fat = 37.78829 +(-1.0185 x Age) + (0.02728 x Age2) + (-0.000202 x Age3)
The standard deviation of the reference population was set at 7%.
This data supports Asian patients only.
China/Asia
● 268 subjects (Beijing)
● 742 subjects (Guangzhou)
Data were pooled and average results by decade from age 20-75 years were fitted
to a function of log age.
Results:
%Fat = 11.22 + 6.124*ln(age).
The standard deviation of the reference population was set at 5.3%.
Body Composition Reference Data for Male

Percent Fat
USA/Northern Europe
● 276 subjects pooled from several research institutions (The Monarch Foundation,
Cincinnati, Ohio; Cavendish Clinic, London, UK; Addenbrookes Hospital, Cambridge,
UK; Alexandra Hospital, Sydney, Australia)
● 676 male subjects pooled from various literature sources [14,15, 19, 23, 24, 26-28]
Data were pooled and grouped by decade from age 20-79 years and fitted to a 3rd
order polynomial.
Results:
The equation for age-matched mean %Fat
%Fat = -0.806 + (0.94 x age) + (-0.012 x age2) + 0.00005649 x age3).
The mean %Fat for males age 20-29 years was about 16% and gradually increased
to about 27% by age 85 years.
This data is configured to support White patients only.
China/Asia
● 138 subjects (Guangzhou)
Data were pooled and average results by decade from age 20-83 years were fitted
to a function of log age.
Results:
%Fat = -7.708 + 7.756*ln(age).
Body Composition Percent Fat Reference Data

Body Composition age-matched mean %Fat reference data – USA/N. Europe
Age %Fat %Fat
Females Males
25 28.5 16.1
35 30.6 19.8
45 33.4 22.3
55 36.0 24.0
Age %Fat %Fat

Females Males
65 37.6 25.1
75 37.5 26.0
85 35.3 27.1
Body Composition age-matched mean %Fat reference data – Japan/Korea

Females
Age %Fat
Females
25 26.4
35 26.4
45 29.0
55 31.3
65 30.7
75 29.9
Body Composition age-matched mean %Fat reference data – China/Asia

Age %Fat %Fat Males
Females
20 29.6 15.5
30 32.0 18.7
40 33.8 20.9
50 35.2 22.6
60 36.3 24.0
70 37.2 25.2
80 38.1 26.3
Age-Matched mean %Fat vs. Age for males and females – USA/N. Europe
Age-Matched mean %Fat vs. Age for females - Japan/Korea
Age-Matched mean %Fat vs. Age for females – China/Asia
Age-Matched mean %Fat vs. Age for males – China/Asia
References
1. Kooh SW, Noriega E, Leslie K, Muller C, Harrision JE (1996) Bone mass and soft tissue
composition in adolescents with anorexia nervosa. Bone 19:181-188.
2. Polito A, Cuzzolaro M, Raguzzini A, Censi L, Ferro-Luzzi A (1998) Body composition
changes in anorexia nervosa. Eur J Clin Nutr 52:655-662.
3. Joyce JM, Warren DL, Humphries LL, Smith AJ, Coon JS (1990) Osteoporosis in
women with eating disorders: comparison of physical parameters, exercise, and
menstrual status with SPA and DPA evaluation. J Nucl Med 31:325-331.
4. Carmichael KA, Carmichael DH (1995) Bone metabolism and osteopenia in eating
disorders. Medicine 74:254-267.
5. Grinspoon S, Miller K, Coyle C, Krempin J, Armstrong C, Pitts S, Herzog D, Klibanski A
(1999) Severity of osteopenia in estrogen-deficient women with anorexia nervosa and
hypothalamic amenorrhea. J Clin Endocrinol Metab 84:2049-2055.
6. Lucas AR, Melton III LJ, Crowson CS, O’Fallon WM (1999) Long-term fracture risk
among women with anorexia nervosa: a population-based cohort. Mayo Clin Proc
74:972-977.
7. Soyka LA, Grinspoon S, Levitsky LL, Hergog DB, Klibanski A (1999) The effects of
anorexia nervosa on bone metabolism in female adolescents. J Clin Endocrinol
Metab84: 4489-4496.
8. Haymond MW, Sundhag AL, Ellis KJ (1999) Body composition as a clinical endpoint
in the treatment of growth hormone deficiency. Horm Res 51(Suppl 3):132-144.
9. Shih R, Wang Z, Heo M, Wang W, Heymsfield SB (2000) Lower limb skeletal muscle
mass: development of dual-energy X-ray absorptiometry prediction model. J Appl
Physiol 89:1380-1386.
10. Suttmann U, Ockenga J, Selberg O, Hoogestraat L, Deicher H, Muller MJ
(1995) Incidence and prognostic value of malnutrition and wasting in human
immunodeficiency virus-infected outpatients. J Acquir Immune Defic Syndr Hum
Retrovirol 8:239-246.
11. Grinspoon S, Corcoran C, Miller K, Biller BMK, Askari H, Wang E, Jubbard J,
Anderson EJ, Basgoz N, Heller HM, Klibanski A (1997) Body composition and endocrine
function in women with acquired immunodeficiency syndrome wasting. J Clin
Endocrinol Metab 82:1332-1337.
12. Monarch Foundation, Cincinnati, Ohio. Personal communication.
13. Grinspoon S, Corcoran C, Askair H, Schoenfeld D, Wolf L, Burrows B, Walsh M,
Hayden D, Pearlman K, Anderson E, Bagoz N, Klibanski A (1998) Effects of androgen
administration in men with the AIDS wasting syndrome. Ann Intern Med 129:18-26.
14. Baumgartner RN, Stauber PM, McHugh D, Koehler KM, Garry PJ (1995)
Cross-sectional age differences in body composition in persons 60+ years of age. J
Gerontol 50A:M307-M316.
15. Karlsson MK, Gardsell P, Johnell O, Nilsson BE, Akesson K, Obrant KJ (1993) Bone
mineral normative data in Malmo, Sweden. Acta Orthop Scand 64:168-172.
16. Mautalen C, Bagur A, Vega E, Gonzalez D (1996) Body composition in normal and
osteoporotic women. Medicina 56:29-34.
17. Svendsen OL, Hassager C, Christiansen C Z (1995) Age- and menopause-associated

variations in body composition and fat distribution in healthy women as measured by
dual-energy X-ray absorptiometry. Metabolism 44:369-373.
18. Matkovic V, Jelic T, Wardlaw GM (1994) Timing of peak bone mass in Caucasian
females and its implications for the prevention of osteoporosis. J Clin Invest
93:799-808.
19. Reid IR, Plank LD, Evans MC (1992) Fat mass is an important determinant of
whole body bone density in premenopausal women, but not in men. J Clin Endocrinol
Metab 75:779-782.
20. Reid IR, Evans MC, Ames RW (1994) Volumetric bone density of the lumbar spine is
related to fat mass but not lean mass in normal postmenopausal women. Osteoporos
Int 4:362-367.
21. Dawson-Hughes B, Harris S (1992) Regional changes in body composition by time
of year in healthy postmenopausal women. Am J Clin Nutr 56:307-313.
22. Compston JE, Bhambhani M, Laskey MA, Murphey S, Khaw KT (1992) Body
composition and bone mass in post-menopausal women. Clin Endocrinol 37:426-431.
23. Ley CJ, Lees B, Stevenson JC (1992) Sex-and menopause-associated changes in
body-fat distribution. Am J Clin Nutr 55:950-954.
24. Beshyah SA, Freemantle C, Thomas E, Rutherford O, Page B, Murphy M, Johnston
DG (1995) Abnormal body composition and reduced bone mass in growth hormone
deficient hypopituitary adults. Clin Endocrinol 42:179-189.
25. Parsons TJ, Prentice A, Smith EA, Cole TJ, Compston JE (1996) Bone mineral mass
consolidated in young British adults. J Bone Miner Res 11:264-274.
26. Krall EA, Dawson-Hughes B (1995) Soft tissue body composition: familial
resemblance and independent influences on bone mineral data. J Bone Miner Res
10:1944-1950.
27. Nuti R, Martini G, Gennari C (1995) Age-related changes of whole skeletal and
body-fat distribution. Calcif Tissue Int 57:336-339.
28. Proctor DN, O’Brien PC, Atkinson EJ, Nair KS (1999) Comparison of techniques to
estimate total body skeletal muscle in people of different age groups. Am J Physiol
277:E489-495.
29. Ohmura A et al., Bone Density and Body Composition in Japanese Women, Calcif
Tissue Int. 1997;61:117-122).
USA (NHANES 1999-2004) Total Body
F
Reference Data
Introduction
enCORE reference data includes an option based on the National Health and Nutrition
Examination Survey (NHANES) which supports adult and pediatric comparisons for
total body bone and body composition results.
Since 1999, the National Center for Health Statistics of the Centers for Disease
Control and Prevention conducts an annual survey in the United States called
The National Health and Nutrition Examination Survey (NHANES). The NHANES
survey data is released on public use data files in two-year increments (e.g.,
NHANES 1999-2000, NHANES 2001-2002, NHANES 2003-2004, etc.). It consists of a
cross-sectional interview, examination, and laboratory data collected from a complex
multistage, stratified, clustered probability sample representative of the civilian,
non-institutionalized population with oversampling of persons over 60 years and
older, African American, and Hispanics. In 2008, six years of survey data (from 1999
through 2004) consisting of total body DXA body composition measurements results
was released (NHANES 1999-2004) (http://www.cdc.gov/nchs/nhanes/dxx/dxa.htm).
In total, the NHANES 1999-2004 survey data included total body DXA scans on a
sample of 22,000 Americans from 8 to over 85 years of age. This survey data was
collected on Hologic bone densitometers.
To provide NHANES reference data in units useful to users of GE Healthcare systems,
Hologic/GE (Lunar) cross-calibration equations were developed by the University of
California San Francisco (UCSF) for the following parameters: Total Body BMD, Total
Body BMC, Total Body Area, Total Body %Fat, Total Body Lean Mass (Soft Tissue), Total
Body Fat Mass, Appendicular Lean Mass (Soft Tissue), Trunk %Fat, Legs %Fat, Trunk
Fat Mass, Legs Fat Mass, Subtotal Body (Less Head) BMD, Subtotal (Less Head) BMC.
Z-scores and centiles can be used to compare a measurement to a reference value.
The Z-score is the number of standard deviations away from the average value of the
reference population. The centile is the percent of people in the reference population
who have a lower value. A person who is average has a Z-score of zero and is at
the 50th centile
The LMS statistical method was used to construct reference curves for dependent
variables versus independent variables [Cole and Green]. Sex and ethnicity specific
curves were constructed for each measurement dependent variables. The LMS
technique estimates three parameters: median (M), coefficient of variation (S), and
power in the Box-Cox transformation (L). These three parameters vary as a function of
USA (NHANES 1999-2004) Total Body Reference Data
independent variables. Once these parameters were estimated, then centile curves
were constructed using the formulas:
Formula 1a: centile = M (1 + L·S·Z)^(1/L) (L≠0)
Formula 1b: centile = M·exp (1 + S·Z) (L=0)
where Z is the Z-score that corresponds to a given percentile. The LMS parameters
calculated from the independent variable are entered into the equation to calculate
the dependent value for that percentile. A Z-score for an individual DXA measurement
is calculated using the L, M and S parameters. The formula used to obtain the Z-score
for an individual is:
Formula 2a: Z = [(X/M)^L) – 1] / L·S (L≠0)
Formula 2b: Z = ln(X/M) / S (L=0)
where X is the physical measurement (e.g. whole body BMD).
The LMS values were fit using lmsChartMaker Version 2.52, Worm plots were used to
assess goodness of fit [Pan and Cole. 2004].
Generation of equations to describe the LMS tables was performed using TableCurve
2D version 5.01.01 software (Systat Software, Inc., Chicago, IL). Regression equations
fitting the table L, M and S parameters were selected from a list of approximating
functions. The selected functions maximized the coefficient of determination subject
to constraints. The enCORE software uses the equations for interpolation and limited
extrapolation of the LMS parameters over defined ranges of the covariates.
For users of GE Healthcare DXA densitometers, Lunar/NHANES reference tables
were generated for the following relationships (sex=male, female; ethnicities=white,
black, Mexican American), and age groups (Children=8 to 19 years old, Adults=20 to
85 years old).
Relationship Age Group
Total Body BMD versus Age Children, Adults
Total Body BMC versus Age Children, Adults
Total Body % Fat versus Age Children, Adults
Total Body Lean Mass / Height2 versus Age Children, Adults
Total Body Fat Mass / Height2 versus Age Adults
Appendicular (Limb) Lean Mass / Height2 versus Age Adults
Trunk %Fat / Legs %Fat versus Age Adults
Relationship Age Group
Trunk Fat Mass / Appendicular (Limb) Fat Mass Adults

versus Age
Subtotal Body (Less Head) BMD versus Age Children
Subtotal Body (Less Head) BMC versus Age Children
Total Body BMD versus Height Children
Total Body BMC versus Height Children
Subtotal Body (Less Head) BMD versus Height Children
Subtotal Body (Less Head) BMC versus Height Children
Total Body Lean Mass versus Height Children
Subtotal Body (Less Head) BMC versus Total Body Children

Lean Mass
Total Body BMC versus Total Body Area Children
Total Body BMC versus Total Body Lean Mass Children
Total Body Area versus Height Children
Subtotal Body (Less Head) BMC versus Subtotal Body Children

(Headless) Area
Notes:
1. Because of upper limits on weight and height of subjects being scanned,
NHANES imputed the subjects’ DXA results for those subjects over the weight
and height limit of the Hologic scanner. To accurately generate the centiles for
the DXA measures, subjects over 136 kg (300 lbs) were excluded from the final
Lunar/NHANES reference data.
2. Reference values are generated for region %Fat (not tissue %Fat).
3. If Hispanic ethnicity is selected, reference values will be based on
Mexican-American NHANES study subjects.
4. The NHANES total body adult reference data, collected from a representative
sample of the American population from 1999 through 2004, is different from
the USA (Lunar) reference data which included U.S. and Northern European
populations collected using stricter exclusion criteria. The NHANES total body
pediatric BMD reference data, collected from a representative sample of American
children from 1999 through 2004, is different from the USA (Lunar) and BMDCS
pediatric reference data, collected using stricter exclusion criteria.
5. For Adult total body BMD measurements, there are no T-scores generated when
using NHANES 1999-2004. An age-matched comparison is the preferred method
when using NHANES 1999-2004 reference population given its broad inclusion
criteria.
References:
1. UCSF FINAL STUDY REPORT: Standardization of Total Body Bone Density and Body
Composition between Hologic and GE Lunar, Investigators: J. A. Shepherd, Ph.D.,
Bo Fan, MD, X.P.Wu, MD, M.A.Levine, MD
2. Cole, T. J. and P. J. Green (1992). "Smoothing reference centile curves: the LMS
method and penalized likelihood." Stat Med11(10): 1305-19.
3. Pan, H. and T. J. Cole (2004). "A comparison of goodness of fit tests for age-related
reference ranges." Stat Med 23(11): 1749-65.
NHANES 1999-2004 Reference Population

LMS reference data for some of the NHANES (1999-2004) Total Body relationships are
shown below including:
● Adult Total Body BMD
● Adult Total Body % Fat
● Pediatric Total Body BMD
● Pediatric Subtotal (TBLH) BMD
● Pediatric Total Body % Fat
Adult White Male Centiles
Adult White Male Total Body BMD vs Age Centiles

LMS Parameters Centiles
Age L M S 10% 25% 50% 75% 90%
20 0.7575 1.216 0.096 1.070 1.138 1.216 1.295 1.367
25 0.7632 1.232 0.096 1.082 1.153 1.232 1.313 1.387
30 0.7485 1.244 0.097 1.091 1.163 1.244 1.326 1.401
35 0.7324 1.250 0.098 1.096 1.168 1.250 1.334 1.410
40 0.7167 1.252 0.099 1.097 1.170 1.252 1.336 1.413
45 0.7013 1.250 0.099 1.094 1.167 1.250 1.335 1.413
50 0.6863 1.246 0.100 1.089 1.162 1.246 1.331 1.409
55 0.6714 1.238 0.101 1.081 1.155 1.238 1.323 1.401
60 0.6566 1.228 0.102 1.071 1.145 1.228 1.313 1.391
65 0.6417 1.214 0.102 1.059 1.132 1.214 1.299 1.377
70 0.6266 1.198 0.103 1.044 1.116 1.198 1.282 1.360

75 0.6112 1.178 0.104 1.026 1.097 1.178 1.262 1.339
80 0.5956 1.156 0.104 1.006 1.076 1.156 1.239 1.315
85 0.5796 1.134 0.105 0.985 1.055 1.134 1.216 1.291
Adult White Male Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -0.3825 22.7 0.300 15.8 18.7 22.7 28.0 34.3
25 -0.1037 24.5 0.282 17.2 20.3 24.5 29.7 35.4
30 0.1380 26.0 0.264 18.4 21.7 26.0 31.0 36.2
35 0.3520 27.3 0.248 19.5 23.0 27.3 32.1 36.9
40 0.5365 28.4 0.232 20.5 24.1 28.4 33.0 37.4
45 0.6883 29.3 0.219 21.5 25.1 29.3 33.8 37.9
50 0.8085 30.3 0.207 22.5 26.1 30.3 34.6 38.5
55 0.9030 31.1 0.197 23.4 27.0 31.1 35.3 39.1
60 0.9793 31.9 0.189 24.2 27.9 31.9 36.0 39.7
65 1.0440 32.5 0.182 24.9 28.5 32.5 36.5 40.0
70 1.1018 32.8 0.176 25.4 28.9 32.8 36.7 40.2
75 1.1559 33.0 0.170 25.7 29.2 33.0 36.7 40.1
80 1.2085 33.0 0.165 25.9 29.3 33.0 36.6 39.8
85 1.2608 32.9 0.159 26.0 29.3 32.9 36.4 39.4
Adult White Female Centiles
Adult White Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -0.0041 1.107 0.088 0.989 1.043 1.107 1.175 1.240
25 0.1137 1.130 0.089 1.007 1.064 1.130 1.199 1.265
30 0.1711 1.141 0.090 1.016 1.074 1.141 1.213 1.280
35 0.2313 1.148 0.092 1.019 1.079 1.148 1.221 1.289
40 0.2875 1.149 0.094 1.017 1.078 1.149 1.223 1.293
45 0.3329 1.143 0.096 1.008 1.071 1.143 1.219 1.290
50 0.3667 1.132 0.099 0.994 1.058 1.132 1.209 1.281
55 0.3919 1.114 0.102 0.973 1.038 1.114 1.192 1.266
60 0.4123 1.091 0.106 0.948 1.014 1.091 1.170 1.245
65 0.4307 1.063 0.109 0.920 0.986 1.063 1.143 1.218
70 0.4493 1.032 0.113 0.889 0.955 1.032 1.112 1.186

75 0.4695 0.998 0.115 0.856 0.922 0.998 1.077 1.151
80 0.4926 0.962 0.118 0.822 0.887 0.962 1.041 1.114
85 0.5195 0.926 0.121 0.788 0.852 0.926 1.003 1.075
Adult White Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 0.5210 38.6 0.212 28.8 33.3 38.6 44.3 49.8
25 0.6706 39.9 0.206 29.9 34.5 39.9 45.6 50.9
30 0.8500 40.4 0.199 30.4 35.1 40.4 45.9 50.9
35 1.0312 40.9 0.191 30.8 35.6 40.9 46.1 50.8
40 1.2118 41.4 0.183 31.5 36.3 41.4 46.5 50.9
45 1.3918 42.3 0.174 32.4 37.2 42.3 47.2 51.4
50 1.5713 43.4 0.166 33.5 38.4 43.4 48.1 52.1
55 1.7507 44.5 0.157 34.7 39.6 44.5 49.0 52.9
60 1.9301 45.4 0.149 35.8 40.6 45.4 49.7 53.4
65 2.1096 45.9 0.142 36.5 41.2 45.9 50.0 53.5
70 2.2894 45.9 0.135 36.8 41.4 45.9 49.9 53.1
75 2.4696 45.6 0.130 36.8 41.3 45.6 49.4 52.5
80 2.6501 45.1 0.125 36.7 41.0 45.1 48.7 51.6
85 2.8310 44.6 0.121 36.4 40.6 44.6 47.9 50.7
Adult Black Male Centiles
Adult Black Male Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 0.1132 1.280 0.0994 1.126 1.197 1.280 1.369 1.453
25 -0.3485 1.309 0.0984 1.157 1.226 1.309 1.400 1.490
30 -0.3488 1.310 0.0992 1.157 1.227 1.310 1.402 1.492
35 -0.3403 1.310 0.0993 1.157 1.226 1.310 1.402 1.493
40 -0.3059 1.308 0.0999 1.154 1.224 1.308 1.400 1.491
45 -0.2272 1.303 0.1010 1.147 1.218 1.303 1.396 1.486
50 -0.1291 1.296 0.1021 1.139 1.210 1.296 1.389 1.479
55 -0.0271 1.288 0.1033 1.129 1.202 1.288 1.382 1.471
60 0.0807 1.279 0.1048 1.117 1.191 1.279 1.372 1.462
65 0.1979 1.266 0.1067 1.102 1.177 1.266 1.359 1.448
70 0.3078 1.246 0.1094 1.080 1.157 1.246 1.341 1.430

75 0.3765 1.223 0.1130 1.054 1.132 1.223 1.318 1.408
80 0.3958 1.198 0.1169 1.027 1.106 1.198 1.295 1.386
85 0.3877 1.175 0.1209 1.001 1.082 1.175 1.273 1.366
Adult Black Male Total Body%Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -1.1072 17.9 0.315 12.8 14.8 17.9 22.8 30.6
25 -0.7958 19.7 0.313 13.9 16.2 19.7 24.9 32.0
30 -0.5174 21.4 0.308 15.0 17.6 21.4 26.7 33.3
35 -0.2386 23.2 0.300 16.0 19.0 23.2 28.5 34.7
40 0.0405 24.7 0.290 17.0 20.3 24.7 30.0 35.7
45 0.3198 25.9 0.279 17.7 21.3 25.9 31.0 36.3
50 0.5991 26.9 0.267 18.4 22.3 26.9 32.0 36.8
55 0.8786 28.0 0.255 19.0 23.2 28.0 32.8 37.3
60 1.1582 28.9 0.241 19.7 24.1 28.9 33.6 37.7
65 1.4379 29.8 0.228 20.4 25.1 29.8 34.2 38.0
70 1.7176 30.6 0.214 21.2 26.0 30.6 34.8 38.3
75 1.9974 31.4 0.199 22.0 26.8 31.4 35.3 38.6
80 2.2772 32.1 0.184 22.9 27.7 32.1 35.8 38.7
85 2.5572 32.7 0.168 23.9 28.6 32.7 36.1 38.8
Adult Black Female Centiles
Adult Black Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -1.9348 1.174 0.092 1.056 1.107 1.174 1.253 1.341
25 -1.5661 1.203 0.091 1.080 1.134 1.203 1.283 1.368
30 -1.2034 1.222 0.091 1.096 1.152 1.222 1.303 1.386
35 -0.8202 1.232 0.092 1.101 1.160 1.232 1.313 1.394
40 -0.4248 1.233 0.093 1.097 1.158 1.233 1.314 1.394
45 -0.0517 1.225 0.096 1.084 1.149 1.225 1.307 1.386
50 0.2603 1.211 0.099 1.064 1.132 1.211 1.294 1.372
55 0.4902 1.191 0.103 1.039 1.110 1.191 1.275 1.353
60 0.6402 1.166 0.106 1.011 1.083 1.166 1.250 1.328
65 0.7260 1.137 0.110 0.980 1.054 1.137 1.222 1.300
70 0.7668 1.105 0.113 0.947 1.021 1.105 1.190 1.268

75 0.7786 1.069 0.117 0.912 0.986 1.069 1.154 1.232
80 0.7731 1.031 0.120 0.875 0.948 1.031 1.115 1.192
85 0.7578 0.990 0.124 0.837 0.909 0.990 1.074 1.150
Adult Black Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 0.6212 37.5 0.236 26.8 31.7 37.5 43.6 49.4
25 0.8293 39.7 0.218 28.9 33.9 39.7 45.6 51.0
30 1.0332 41.3 0.201 30.6 35.7 41.3 46.9 51.9
35 1.2371 42.4 0.186 32.0 37.0 42.4 47.7 52.3
40 1.4410 43.4 0.172 33.3 38.2 43.4 48.3 52.5
45 1.6449 44.2 0.160 34.4 39.3 44.2 48.9 52.8
50 1.8488 45.0 0.151 35.4 40.2 45.0 49.4 53.1
55 2.0527 45.6 0.144 36.1 40.9 45.6 49.8 53.3
60 2.2566 45.9 0.139 36.6 41.4 45.9 50.0 53.3
65 2.4605 46.1 0.135 36.8 41.6 46.1 50.1 53.3
70 2.6644 46.1 0.132 36.8 41.7 46.1 49.9 53.0
75 2.8683 45.7 0.129 36.5 41.3 45.7 49.4 52.3
80 3.0722 45.0 0.127 35.9 40.7 45.0 48.5 51.3
85 3.2761 44.0 0.124 35.1 39.9 44.0 47.3 50.0
Adult Mexican-American Male Centiles
Adult Mex-Am Male Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -0.5381 1.152 0.102 1.015 1.077 1.152 1.235 1.318
25 -0.8166 1.166 0.099 1.033 1.093 1.166 1.250 1.334
30 -0.9339 1.177 0.098 1.045 1.104 1.177 1.259 1.344
35 -0.9294 1.182 0.096 1.052 1.110 1.182 1.264 1.348
40 -0.8332 1.184 0.096 1.053 1.111 1.184 1.265 1.347
45 -0.6679 1.182 0.096 1.051 1.110 1.182 1.263 1.344
50 -0.4496 1.180 0.096 1.047 1.107 1.180 1.259 1.338
55 -0.1887 1.176 0.096 1.041 1.102 1.176 1.255 1.331
60 0.1070 1.170 0.097 1.033 1.096 1.170 1.249 1.323
65 0.4292 1.163 0.097 1.023 1.088 1.163 1.241 1.313
70 0.7677 1.154 0.098 1.010 1.078 1.154 1.231 1.301

75 1.1131 1.143 0.099 0.996 1.066 1.143 1.219 1.287
80 1.4588 1.131 0.100 0.980 1.053 1.131 1.206 1.272
85 1.8011 1.118 0.102 0.964 1.039 1.118 1.193 1.257
Adult Mexican-American Male Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -0.3564 23.9 0.290 16.8 19.8 23.9 29.2 35.5
25 -0.1201 25.4 0.267 18.1 21.2 25.4 30.4 36.0
30 0.0678 26.8 0.245 19.5 22.7 26.8 31.5 36.5
35 0.2499 28.0 0.225 20.7 24.0 28.0 32.5 37.0
40 0.4317 29.0 0.209 21.8 25.1 29.0 33.3 37.4
45 0.6142 29.9 0.195 22.8 26.0 29.9 33.9 37.7
50 0.7974 30.6 0.184 23.6 26.9 30.6 34.5 38.0
55 0.9808 31.2 0.175 24.2 27.5 31.2 34.9 38.2
60 1.1645 31.7 0.167 24.8 28.1 31.7 35.2 38.4
65 1.3480 32.1 0.160 25.2 28.5 32.1 35.5 38.4
70 1.5314 32.4 0.153 25.6 28.9 32.4 35.6 38.4
75 1.7143 32.6 0.147 26.0 29.2 32.6 35.7 38.4
80 1.8968 32.7 0.141 26.3 29.5 32.7 35.7 38.2
85 2.0788 32.8 0.134 26.5 29.7 32.8 35.7 38.0
Adult Mexican-American Female Centiles
Adult Mexican-American Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 -0.0472 1.066 0.090 0.950 1.003 1.066 1.132 1.196
25 0.1474 1.086 0.089 0.968 1.023 1.086 1.153 1.216
30 0.2738 1.107 0.090 0.985 1.041 1.107 1.175 1.239
35 0.3913 1.122 0.091 0.995 1.054 1.122 1.192 1.257
40 0.5036 1.127 0.094 0.996 1.057 1.127 1.199 1.266
45 0.6032 1.121 0.097 0.985 1.048 1.121 1.195 1.264
50 0.6859 1.104 0.101 0.963 1.029 1.104 1.180 1.250
55 0.7520 1.078 0.106 0.934 1.001 1.078 1.155 1.227
60 0.8036 1.047 0.111 0.900 0.969 1.047 1.125 1.197
65 0.8432 1.013 0.116 0.864 0.934 1.013 1.092 1.165
70 0.8703 0.978 0.121 0.828 0.898 0.978 1.058 1.131

75 0.8831 0.944 0.126 0.793 0.864 0.944 1.025 1.098
80 0.8847 0.912 0.131 0.760 0.831 0.912 0.993 1.067
85 0.8812 0.881 0.137 0.729 0.800 0.881 0.963 1.037
Adult Mex-Am Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
20 1.0704 40.1 0.157 32.0 35.8 40.1 44.3 48.1
25 1.1343 41.3 0.150 33.3 37.1 41.3 45.4 49.1
30 1.2603 42.4 0.141 34.5 38.3 42.4 46.4 49.9
35 1.3884 43.3 0.134 35.6 39.3 43.3 47.2 50.5
40 1.5165 44.2 0.129 36.5 40.2 44.2 47.9 51.2
45 1.6445 45.0 0.125 37.4 41.1 45.0 48.6 51.8
50 1.7726 45.6 0.121 38.1 41.8 45.6 49.2 52.3
55 1.9006 46.1 0.119 38.6 42.3 46.1 49.7 52.7
60 2.0286 46.5 0.117 38.8 42.6 46.5 50.0 53.0
65 2.1566 46.7 0.117 38.9 42.8 46.7 50.2 53.2
70 2.2847 46.7 0.118 38.8 42.8 46.7 50.3 53.2
75 2.4127 46.7 0.119 38.6 42.7 46.7 50.3 53.2
80 2.5407 46.7 0.121 38.3 42.6 46.7 50.3 53.2
85 2.6688 46.7 0.123 38.1 42.5 46.7 50.3 53.2
Pediatric White Male Centiles
Pediatric White Male Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.2030 0.769 0.0635 0.709 0.737 0.769 0.803 0.834
10 -0.0362 0.811 0.0707 0.741 0.774 0.811 0.851 0.888
12 -0.2398 0.867 0.0804 0.783 0.822 0.867 0.916 0.962
14 -0.0706 0.973 0.0929 0.865 0.914 0.973 1.037 1.097
16 0.6035 1.112 0.0985 0.976 1.039 1.112 1.187 1.256
18 0.7710 1.199 0.0965 1.053 1.121 1.199 1.277 1.349
20 0.7575 1.216 0.0955 1.070 1.138 1.216 1.295 1.367
Pediatric White Male Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.5392 0.632 0.0813 0.568 0.598 0.632 0.667 0.699

10 0.1929 0.691 0.0907 0.614 0.650 0.691 0.734 0.775
12 -0.0468 0.770 0.1016 0.676 0.719 0.770 0.825 0.878
14 0.1481 0.896 0.1111 0.776 0.831 0.896 0.965 1.032
16 0.7169 1.028 0.1120 0.883 0.951 1.028 1.106 1.178
18 1.0900 1.105 0.1085 0.950 1.024 1.105 1.186 1.258
20 1.1630 1.125 0.1071 0.968 1.043 1.125 1.205 1.277
Pediatric White Male Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.4925 28.6 0.257 21.1 24.2 28.6 34.2 40.9
10 -0.4786 27.4 0.276 19.7 22.9 27.4 33.3 40.4
12 -0.4646 25.9 0.295 18.3 21.4 25.9 31.9 39.2
14 -0.4506 24.0 0.310 16.7 19.7 24.0 29.9 37.2
16 -0.4368 22.5 0.317 15.5 18.3 22.5 28.1 35.2
18 -0.4249 22.2 0.314 15.3 18.1 22.2 27.7 34.4
20 -0.3825 22.7 0.300 15.8 18.7 22.7 28.0 34.4
Pediatric White Female Centiles
Pediatric White Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.2287 0.735 0.0679 0.673 0.702 0.735 0.769 0.801
10 0.1658 0.801 0.0782 0.724 0.759 0.801 0.844 0.884
12 0.0954 0.890 0.0880 0.795 0.839 0.890 0.944 0.996
14 0.0283 0.985 0.0930 0.874 0.925 0.985 1.048 1.109
16 -0.0235 1.048 0.0929 0.931 0.985 1.048 1.116 1.181
18 -0.0470 1.084 0.0904 0.966 1.020 1.084 1.152 1.218
20 -0.0040 1.107 0.0883 0.989 1.043 1.107 1.175 1.240
Pediatric White Female Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.9232 0.614 0.0906 0.550 0.579 0.614 0.654 0.694

10 -0.5930 0.704 0.0993 0.623 0.659 0.704 0.754 0.804
12 -0.3246 0.806 0.1061 0.706 0.751 0.806 0.867 0.926
14 -0.2019 0.894 0.1084 0.780 0.832 0.894 0.963 1.029
16 -0.2378 0.949 0.1070 0.829 0.883 0.949 1.020 1.091
18 -0.3075 0.978 0.1039 0.858 0.913 0.978 1.050 1.121
20 -0.3096 0.992 0.1020 0.873 0.927 0.992 1.064 1.134
Pediatric White Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.4186 33.0 0.224 25.2 28.5 33.0 38.6 44.8
10 -0.2901 32.9 0.222 25.1 28.5 32.9 38.4 44.3
12 -0.1671 32.8 0.219 24.9 28.3 32.8 38.1 43.7
14 -0.0463 33.0 0.216 25.1 28.5 33.0 38.2 43.6
16 0.1012 34.1 0.212 25.9 29.5 34.1 39.3 44.5
18 0.3272 36.3 0.211 27.3 31.4 36.3 41.7 47.1
20 0.5210 38.6 0.212 28.8 33.3 38.6 44.3 49.8
Pediatric Black Male Centiles
Pediatric Black Male Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.2585 0.810 0.0716 0.738 0.771 0.810 0.850 0.887
10 0.1729 0.858 0.0783 0.776 0.814 0.858 0.905 0.948
12 0.0689 0.921 0.0884 0.822 0.868 0.921 0.978 1.032
14 0.1301 1.034 0.1049 0.903 0.963 1.034 1.109 1.181
16 0.4287 1.165 0.1072 1.012 1.083 1.165 1.251 1.332
18 0.3388 1.250 0.1015 1.094 1.166 1.250 1.337 1.419
20 0.1132 1.280 0.0994 1.126 1.197 1.280 1.369 1.453
Pediatric Black Male Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.5523 0.660 0.1039 0.574 0.614 0.660 0.706 0.750

10 0.5237 0.736 0.1068 0.639 0.684 0.736 0.790 0.841
12 0.4916 0.829 0.1099 0.716 0.769 0.829 0.891 0.950
14 0.4563 0.958 0.1133 0.824 0.886 0.958 1.032 1.102
16 0.4204 1.086 0.1163 0.931 1.002 1.086 1.173 1.254
18 0.3978 1.164 0.1184 0.995 1.073 1.164 1.259 1.348
20 0.3560 1.190 0.1185 1.018 1.097 1.190 1.287 1.379
Pediatric Black Male Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.5753 25.1 0.296 17.8 20.7 25.1 31.0 38.4
10 -0.6942 23.7 0.308 16.8 19.6 23.7 29.7 37.7
12 -0.8147 22.2 0.318 15.6 18.3 22.2 28.2 36.5
14 -0.9330 20.4 0.324 14.4 16.8 20.4 26.1 34.6
16 -1.0375 18.7 0.324 13.2 15.4 18.7 24.0 32.2
18 -1.1225 17.7 0.319 12.6 14.6 17.7 22.6 30.6
20 -1.1073 17.9 0.315 12.8 14.8 17.9 22.8 30.6
Pediatric Black Female Centiles
Pediatric Black Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 2.0418 0.769 0.0682 0.699 0.733 0.769 0.804 0.834
10 1.0085 0.863 0.0843 0.769 0.814 0.863 0.912 0.956
12 -0.0017 0.966 0.0975 0.853 0.905 0.966 1.032 1.095
14 -0.8856 1.060 0.1011 0.937 0.992 1.060 1.137 1.216
16 -1.5267 1.121 0.0977 1.000 1.053 1.121 1.202 1.289
18 -1.9063 1.159 0.0930 1.041 1.093 1.159 1.239 1.327
20 -1.9349 1.174 0.0915 1.056 1.107 1.174 1.253 1.341
Pediatric Black Female Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 2.2442 0.659 0.1057 0.560 0.609 0.659 0.704 0.741

10 1.1083 0.767 0.1066 0.662 0.712 0.767 0.822 0.871
12 0.0407 0.882 0.1074 0.768 0.820 0.882 0.948 1.011
14 -0.8140 0.970 0.1081 0.851 0.904 0.970 1.046 1.123
16 -1.3555 1.017 0.1085 0.896 0.949 1.017 1.099 1.187
18 -1.5957 1.035 0.1088 0.912 0.966 1.035 1.119 1.212
20 -1.5892 1.040 0.1089 0.917 0.970 1.040 1.124 1.217
Pediatric Black Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.0608 30.4 0.264 21.8 25.5 30.4 36.4 42.8
10 0.0073 31.0 0.263 22.1 25.9 31.0 37.0 43.4
12 0.0702 31.4 0.262 22.4 26.3 31.4 37.5 43.8
14 0.1676 32.3 0.260 22.9 27.0 32.3 38.4 44.7
16 0.3179 33.9 0.257 24.0 28.4 33.9 40.2 46.4
18 0.4927 36.0 0.247 25.5 30.3 36.0 42.2 48.3
20 0.6212 37.5 0.236 26.8 31.7 37.5 43.6 49.4
Pediatric Mexican-American Male Centiles
Pediatric MexAm Male Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.6460 0.751 0.0685 0.690 0.718 0.751 0.787 0.822
10 -0.6574 0.801 0.0771 0.728 0.761 0.801 0.845 0.887
12 -0.5585 0.865 0.0875 0.776 0.816 0.865 0.919 0.972
14 -0.1210 0.969 0.0985 0.855 0.907 0.969 1.036 1.101
16 -0.0011 1.092 0.1021 0.958 1.019 1.092 1.169 1.244
18 -0.4178 1.144 0.1020 1.008 1.069 1.144 1.227 1.309
20 -0.5381 1.152 0.1016 1.015 1.077 1.152 1.235 1.318
Pediatric MexAm Male Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.5913 0.616 0.0926 0.549 0.580 0.616 0.657 0.697

10 -0.3760 0.685 0.1022 0.603 0.640 0.685 0.735 0.784
12 -0.0410 0.773 0.1117 0.670 0.717 0.773 0.833 0.892
14 0.3178 0.896 0.1170 0.769 0.828 0.896 0.969 1.038
16 0.1009 1.012 0.1151 0.873 0.936 1.012 1.094 1.172
18 -0.3043 1.054 0.1136 0.914 0.977 1.054 1.139 1.224
20 -0.3626 1.058 0.1131 0.919 0.981 1.058 1.143 1.228
Pediatric MexAm Male Total Body %Fat Vs Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 0.2024 32.1 0.287 21.9 26.3 32.1 38.8 45.7
10 0.1841 30.7 0.301 20.6 25.0 30.7 37.5 44.6
12 0.1559 29.0 0.313 19.2 23.4 29.0 35.7 42.8
14 0.1015 26.9 0.319 17.7 21.6 26.9 33.3 40.1
16 -0.0020 25.1 0.317 16.7 20.2 25.1 31.1 37.7
18 -0.1910 24.3 0.304 16.7 19.8 24.3 29.9 36.4
20 -0.3563 23.9 0.290 16.8 19.8 23.9 29.2 35.5
Pediatric Mexican American Female Centiles
Pediatric MexAm Female Total Body BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -1.5178 0.713 0.0693 0.656 0.681 0.713 0.748 0.784
10 -1.1394 0.795 0.0835 0.719 0.753 0.795 0.843 0.891
12 -0.7659 0.894 0.0962 0.795 0.839 0.894 0.956 1.018
14 -0.4346 0.985 0.0982 0.871 0.922 0.985 1.053 1.121
16 -0.1962 1.040 0.0932 0.924 0.977 1.040 1.108 1.173
18 -0.0835 1.062 0.0903 0.946 0.999 1.062 1.129 1.193
20 -0.0471 1.066 0.0897 0.950 1.003 1.066 1.132 1.196
Pediatric MexAm Female Subtotal BMD vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.2236 0.590 0.0907 0.526 0.555 0.590 0.627 0.663

10 -0.3360 0.698 0.1030 0.614 0.652 0.698 0.749 0.799
12 -0.4409 0.816 0.1141 0.708 0.757 0.816 0.883 0.949
14 -0.5233 0.899 0.1121 0.783 0.835 0.899 0.971 1.044
16 -0.5722 0.929 0.1054 0.816 0.867 0.929 0.999 1.070
18 -0.5904 0.934 0.1028 0.823 0.873 0.934 1.003 1.072
20 -0.5789 0.936 0.1014 0.826 0.875 0.936 1.004 1.071
Pediatric MexAm Female Total Body %Fat vs. Age Centiles

Age L M S 10% 25% 50% 75% 90%
8 -0.2854 32.3 0.238 24.2 27.7 32.3 38.1 44.5
10 -0.1309 33.5 0.228 25.1 28.7 33.5 39.1 45.1
12 0.0291 34.5 0.218 26.1 29.8 34.5 40.0 45.6
14 0.1899 35.8 0.207 27.3 31.1 35.8 41.1 46.4
16 0.3710 37.3 0.193 28.8 32.7 37.3 42.4 47.3
18 0.6596 38.9 0.174 30.6 34.5 38.9 43.6 48.0
20 1.0708 40.1 0.157 32.0 35.8 40.1 44.3 48.1
AFF Phantom Study Results
G
Introduction
AFF bench testing was performed using a set of 5 anthropomorphic femur phantoms
with simulated beaks of different sizes. Simulated beaks were composed of a calcium
carbonate-based compound that mimics the expected size and density of AFF beaks
in vivo. The projected beaks on all 5 phantoms were measured on Prodigy and iDXA
and the beaking index at each beak compared to expected values measured with
digital calipers.
Accuracy of Beak Size

A linear regression line was fit to the data points to calculate slope and the Pearson
correlation coefficient was calculated. The standard error of the estimate is <0.4 mm
and is the projected beak size accuracy error.
Prodigy and iDXA Projected Beak Size Average Measurements
Value Prodigy Lunar iDXA

SEE* Slope (r2) SEE* Slope (r2)
Beak Index 0.36mm 1.0005(0.9575) 0.33mm 0.9998(0.9608)
*Standard Error of the Estimate
Reproducibility of Beak Size

Intra-scanner reproducibility error was determined from measurements taken
on 5 scanners measuring 5 simulated beaks (range: 1.7 – 5.9 mm) 5 times each.
For Prodigy(iDXA) the intra-scanner reproducibility error was 0.18 mm(0.12 mm).
Inter-scanner reproducibility error for Prodigy(iDXA) was 0.1 mm(0.22 mm). Precision
error is the root mean square of the intra- and inter-scanner reproducibility. For
Prodigy(iDXA) precision error was 0.20 mm(0.25 mm), which is <0.3mm
The accuracy and precision error results from these studies were used to set an
expected error margin of 0.5mm. (Standard deviation = SQRT (0.42 + 0.32)).
Beak Size Dependence on Positioning

Patient positioning influences the beak size measurement since DXA images are
two-dimensional projections. This was investigated by measuring the variation of
phantom beak size under femur rotation and skew (angulation).
Rotation of the femur about the femoral shaft axis from -20° to +20° produced beak
size variation of ±0.5mm.
The 0 degree angle for our phantom study corresponded to the typical position for
patient when using the positioner as instructed in the user manual.
The diagram below shows the femur rotation direction using the patient’s right foot.
- Degree for outward rotation + Degree for inward rotation
Skewing of femur angle relative to the DXA table long axis from -5° to +5° produced
beak size variation of ±0.2mm.
Abduction Adduction
- Degree angulation + Degree angulation
The size of a beak is dependent on its orientation in a two-dimensional DXA

image. The user must use the foot brace to control leg position and can verify
rotation by looking at the prominence of the lesser trochanter on the DXA
scan image. The standard deviation of a beak size measurement is expected
to be 0.5 mm with consistent patient positioning. Clinical measurement
error may vary.
GE Healthcare
www.gehealthcare.com

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GE Healthcare

X-ray Bone Densitometer with enCORE v17

X-ray Bone Densitometer with enCORE

LU43616EN-2EN Revision 19 (September

3 X-ray Bone Densitometer with enCORE v17 software - User Manual

4 X-ray Bone Densitometer with enCORE v17 software - User Manual

5 X-ray Bone Densitometer with enCORE v17 software - User Manual

6 X-ray Bone Densitometer with enCORE v17 software - User Manual

7 X-ray Bone Densitometer with enCORE v17 software - User Manual

8 X-ray Bone Densitometer with enCORE v17 software - User Manual

9 X-ray Bone Densitometer with enCORE v17 software - User Manual

10 X-ray Bone Densitometer with enCORE v17 software - User Manual

11 X-ray Bone Densitometer with enCORE v17 software - User Manual

12 X-ray Bone Densitometer with enCORE v17 software - User Manual

Madison, WI 53718 Fax: +49–212–2802–390

P.O. Box 7550

China France Asia/Pacific

Physical Manufacturer Address Turkey

Nuevo Leon CP 66645 MEXICO

13 X-ray Bone Densitometer with enCORE v17 software - User Manual

Lunar iDXA* Series

Lunar Prodigy* Series

Lunar DPX* Series

14 X-ray Bone Densitometer with enCORE v17 software - User Manual

15 X-ray Bone Densitometer with enCORE v17 software - User Manual

3. TERM AND TERMINATION.

16 X-ray Bone Densitometer with enCORE v17 software - User Manual

17 X-ray Bone Densitometer with enCORE v17 software - User Manual

18 X-ray Bone Densitometer with enCORE v17 software - User Manual

19 X-ray Bone Densitometer with enCORE v17 software - User Manual

Component Description GE Model

Tube head GE Medical Systems Ultrasound & 40782

X-ray controller GE Medical Systems Ultrasound & 41718

Collimator GE Medical Systems Ultrasound & 42129

PRODIGY Advance 301000 and higher, PRODIGY 301000 and higher

Component Description GE Model

X-ray controller GE Medical Systems Ultrasound & 41170

High voltage power GE Medical Systems Ultrasound & 7681

GE Medical Systems Ultrasound

Tube head GE Medical Systems Ultrasound & 8743 or 45645

Collimator GE Medical Systems Ultrasound 8915

20 X-ray Bone Densitometer with enCORE v17 software - User Manual

Component Description GE Model

X-ray controller GE Medical Systems Ultrasound & 7635

High voltage power GE Medical Systems Ultrasound & 7681

GE Medical Systems Ultrasound

Tube head GE Medical Systems Ultrasound & 8743 or 45645

Collimator GE Medical Systems Ultrasound & 8915

DPX-NT/PRO/MD+/72000 and higher/90000 and higher

Component Description GE Model

X-ray controller GE Medical Systems Ultrasound & 7634

High voltage power GE Medical Systems Ultrasound & 7681

GE Medical Systems Ultrasound

21 X-ray Bone Densitometer with enCORE v17 software - User Manual

Tube head assembly GE Medical Systems Ultrasound & 8548 or 45649

Collimator GE Medical Systems Ultrasound & 7767

DPX Duo, DPX Bravo

Component Description GE Model