DPX SERIES OPERATOR TRAINING

FEMUR IMAGE: Acquisition and Analysis

This presentation is designed for use by Applications Instructors

training Operators in the acquisition and analysis of Femur scans.

The first three slides are for instructor use only and NOT for
presentation to customers.
 USE OF THIS PRESENTATION:
NOTES TO THE INSTRUCTOR

• This presentation covers scanning and analysis for DPX series scanners including:
– DPX- IQ, DPX- MD, DPX- A, DPX- alpha, DPX and DPX- L.
• Patient information entry and patient positioning are the same for all scanners.
• Most of the slides in this presentation show examples using IQ software, but may
be applied to training on all systems.
• IMPORTANT: There are differences in scan file analysis and report results between
systems!
– There are different slides outlining the software specific criteria in the analysis
section of this presentation.
• IMPORTANT: There are differences in scan mode selection criteria between
systems!
– There are different slides outlining the table specific criteria in the acquisition
section of this presentation.
• Review Notes Page for slide: 8
 BEGIN CUSTOMER TRAINING
PRESENTATION WITH THE NEXT SLIDE
(Slide # 4)
DPX SERIES OPERATOR TRAINING
FEMUR IMAGE: Acquisition and Analysis

DPX, DPX-L, DPX-A, DPX-alpha

DPX-IQ, DPX-MD
 INTRODUCTION:
Essentials for Accurate and Repeatable Results

• You will learn:

– Proper Patient Positioning
– Correct Scan Mode Selection
– Correct Scan Acquisition
– Correct and Consistent Scan File Analysis
• Improper positioning or incorrect scan acquisition may result in
unreliable scan results and may complicate scan file analysis.
• LUNAR software will correctly auto analyze most scans with proper
patient positioning and correct scan acquisition.
• If you follow the fundamental instructions outlined, you will have
consistent, accurate results and reduce the amount of time you spend
analyzing scans.
 INTRODUCTION:
Scanning the Femur Region

• LUNAR software offers the ability to

1 monitor bone mineral density for:
– Total Body 1
– Spine (AP and Lateral) 2
2 – Forearm 3
– Hand 4
3
5 – Femur 5
– (Orthopedic - not shown)
4
• This tutorial covers scan image
acquisition and analysis for Femur.
• Let’s begin at the main menu of the
LUNAR software.
CHOOSE THE CORRECT SCAN OPTION
• Select FEMUR
OPTIONS, if not
already selected.
• AP SPINE OPTIONS
is the current
selection.
• Press F6 - Select
Scan Type.
• AP Spine is
highlighted.
• Use the arrow key
to highlight FEMUR.
• Press the Esc key to
enable FEMUR
OPTIONS from the
main menu.
Esc F6
 ENTER PATIENT INFORMATION
• Press F1 - Scan Patient.
The Patient Directory
appears.
• Press F1 - Search. Type in
the patient’s last name.
• Press the Esc key.
(“TEACHER” is highlighted,
as it is closest alphabetically
to the name SMITH.)
• If new patient, press F4 - Add
New Patient. The Mandatory
Information screen appears.
SMITH • Type in information.
• Enter Ethnic code.
• Enter Disease codes (up to
3), Fracture codes (up to 3),
or F1 - Optional
Information, if desired.
• Press the Esc key, to begin
Femur Acquisition.
Esc F1 F4
 ENTERING PATIENT INFORMATION:
Avoid Mistakes

• Searching for the patient’s name each time you scan a patient will help
eliminate the mistake of entering a patient multiple times. A patient
should only be entered into a directory ONE time.
• Make sure that the patient’s name has been typed in correctly before
scanning the patient.
– Remember to enter the first name on the first line.
– Do not assume the name typed on your other records has been spelled
correctly. It is best to confirm correct spelling (as well as birth date) with
the patient.
• Measure the patient’s height and weight and enter your measured
values. If a patient is in for a repeat scan, you may need to update the
height and weight values.
• You need only enter the name, birth date, height, weight, sex and
ethnic code to scan a patient. All other information is optional.
CHOOSE SIDE TO BE SCANNED AND CORRECT SCAN MODE
• Choose the patient side
you wish to scan. (Our
patient has an implant in
the right hip, we will
scan the opposite or left
hip.)
• Press F1 - Verify
Values.
• “Right” side is currently
selected.
• Press 2 to select Left.
• The scan mode
currently selected is Hi-
Res Medium 750.
• Measure the thickness
of the patient in the
region to be scanned to
determine if this is the
appropriate scan mode.
F1
 MEASURE PATIENT THICKNESS
IN THE REGION TO BE SCANNED
• Measure the thickness of the patient in the
femur region to determine the correct
scan mode. For DPX-IQ:

CM
30 30cm

Hi-Res Medium 3000

25

22 cm
20
Hi-Res Fast 3000

15 15 cm
Hi-Res Medium 750
12 cm
Our patient is 20cm thick, use Hi-Res Fast 3000. 10
 MEASURE PATIENT THICKNESS
IN THE REGION TO BE SCANNED
• Measure the thickness of the patient in the
femur region to determine the correct
scan mode. For DPX(L, alpha) :

CM
30 30cm
Medium 3000
26 cm
25

20 Fast 3000

15 15 cm
Medium 750
12 cm
Our patient is 20cm thick, use Fast 3000. 10
 MEASURE PATIENT THICKNESS
IN THE REGION TO BE SCANNED
• Measure the thickness of the patient in the
femur region to determine the correct scan
mode. For DPX- MD, DPX, DPX- A:

CM
30 30cm
Detail 750
28 cm
Slow 750
25
24 cm

20
Medium 750
15

12 cm
Our patient is 20cm thick, use Medium 750. 10
(See notes page for this slide.)
CHANGE SCAN MODE, IF NECESSARY
• The appropriate scan
mode for our sample
patient is Hi-Res Fast
3000.
• Press arrow key to
change scan modes. Hi-
Res Medium 750 is
currently highlighted.
• Press the arrow key
to highlight Hi-Res Fast
3000.
• Press the Esc key to
change the scan mode
in the Acquisition
screen.
Home
• Press the Home key to
implement mode
selection.
• Press the Esc key and
Esc position the patient.
 POSITION THE PATIENT PROPERLY
• Proper patient positioning is essential for reproducible results.
• Improper positioning may result in unreliable scan results and
complicate scan file analysis.
• PATIENT’S SHOULDERS SHOULD BE SQUARE.
• PATIENT SHOULD BE CENTERED ON THE TABLE.
• PATIENT’S HIPS SHOULD BE SQUARE.
• REMOVE HEAVILY-ATTENUATING MATERIALS FROM SCAN REGION.

DPX-IQ
 MOVE SCAN ARM AND POSITION FEMUR
• Once the patient is centered and square on the table, press
the Esc key to move the arm to the initial starting position.
• The patient localizer light will illuminate.
• Secure foot of leg NOT being scanned to vertical side of bracket.
• Move foot brace until vertical side is 3cm outside of center line.
• Rotate the leg to be scanned, and secure to the bracket.

DPX-IQ

3 cm

CENTER LINE OF TABLE

 PROPER ROTATION OF THE FEMUR
1. It is very important that the femur be internally
rotated. Turning only the foot does NOT ensure that
the femur has been properly rotated. Support the
patient’s upper thigh and rotate the whole leg. This
will ensure proper rotation of the femur and correct
positioning of the femoral neck for scanning.

2. The lesser trochanter is eliminated from view as

the leg is rotated.

Shaft
3. The neck of the femur becomes parallel to the
table top as the leg is rotated. Neck

4. The rotated leg is pulled away from the center line

of the table (laterally) to position the shaft of the
femur parallel to the center line of the table.
PLACE TISSUE EQUIVALENT MATERIAL, IF NECESSARY
• Thin patients may require the placement of tissue equivalent
material adjacent to the scan region. If the scanner is allowed
to scan beyond the patient into air, this may interfere with the
accurate collection of data.
• Result may be invalid if air is scanned.
• LUNAR has found that bags of uncooked, white rice work well
as tissue equivalent material.

Position tissue
equivalent material
adjacent to region
to be scanned.
Bags should be
placed as shown.

Patient may rest Leg No air gaps

hand on their chest
or adjacent to the
bags.
ADJUST SCAN ARM START POSITION
• Use the directional
switches to center the
localizer light just below the
POWER LASER base of the pubic
symphysis (for IQ and MD)
and even with the base of
the symphysis pubis (for all
others).
• The scan should begin
centered on the thigh.

Center of Table

DPX-IQ 1cm

Center of Thigh
 SCANNING THE FEMUR
WHAT YOU SHOULD SEE WHILE SCANNING

• Scan should continue 25 scan lines

above the top of the greater trochanter.

• Scan should track to the outside of the

greater trochanter.
• Ischium should appear:
– 25 - 45 scan lines after scan starts for
IQ and MD scanners.
– 15 - 30 scan lines after scan starts for
all others.
• Minimum or no lesser trochanter
should be visible - this indicates
proper rotation.
• Scan should begin with shaft of
femur centered in image and
straight.
 ACQUIRE THE FEMUR SCAN IMAGE
• Once the localizer light has
Note: No air in scan been properly positioned over
the patient, press the Esc key
to begin acquisition.
25 lines
• Monitor the first few scan
lines. The shaft should be:
Lesser
Trochanter – 1) Centered in the image.
– 2) Straight in the image.
Ischium • Continue scanning to acquire
a sufficient amount of shaft.
2) Straight Ischium should appear after:
29
120

1) Centered SOURCE N
ON – 25 - 45 scan lines for IQ
and MD scanners.
– 15 - 30 scan lines for all
others.
• Minimal or no lesser
trochanter should be visible.
• Stop scan when 25 scan lines
have been acquired above the
top of the greater trochanter.
• No air should be visible in the
Esc scan.
RESTART SCAN, IF NECESSARY
• If the scan is started in the
wrong position, stop the
scan and reposition the
scan arm.
• This scan started too high.
The ischium appears in the
first few scan lines.
• Press F1 - Abort Scan
Process.
• Answer N (no) to “Continue
scan?” prompt.
29
• Answer Y (yes) to “Restart
SOURCE N
ON
Scan?” prompt. Answer Y
(yes) to “Are you sure?”
prompt.
• Press F1 - Reposition
Scan.
• Adjust the position of the
localizer light using the
positioning switches as
shown before.
• Press the Esc key to rescan
Esc F1 the patient.
 SAVE DATA FOR ANALYSIS
• If the scan auto stops
before 25 lines have been
acquired above the greater
trochanter, answer Y (yes)
to “Continue Scan?”
prompt.
• When the scan is complete,
press F1 - Abort Scan
Process.
• Answer N (no) to “Continue
110
120
SOURCE N
ON
scan?” prompt.
• Answer N (no) to “Restart
Scan?” prompt.
• Answer Y (yes) to “Save
data?” prompt.
• Remove the femur foot
brace.
• The scan arm will return to
home position. Remove
the patient from the table.
Esc F1 • Press the Esc key to return
to the main menu.
 REVIEW FEMUR ANALYSIS
• From the main menu, press
F2 - Analyze Scan.
• Highlight the patient’s name.
1 This patient was just
2 Axis scanned, therefore the name
is already highlighted in the
Patient Directory.
3 • Press the Esc key.
• This scan has not yet been
analyzed and is the scan just
acquired. Press the Esc key
to continue.
• Review the mandatory
information and press the
Esc key to continue.
• Check positioning of neck
ROI:
– It should contain no greater
trochanter. 1
– It should be perpendicular to
the axis of the femoral neck. 2
– It should contain minimal if
any ischium. 3
Esc F2
REPOSITION NECK ROI, IF NECESSARY
IQ AND MD SOFTWARE ONLY
• It is usually not necessary to
intervene with the computer
analysis, if the scan is properly
acquired. This scan has been
modified to illustrate correct
adjustment of the neck ROI if it is
necessary.
• Press F2 - Auto Analysis.
• Use the arrow key to move the
neck ROI to the top (proximal
end) of the femoral neck.
• Press F9 - Search. This key
must be pressed if a change has
been made in the ROI position.
• The software will correctly
position the neck ROI.
• Press the Esc key to return to the
Bone Results screen.

Esc F2 F9
 ANALYZE FEMUR IMAGE
DPX, DPX-L, DPXA, DPX-ALPHA SOFTWARE ONLY
• It is necessary to analyze
1 scans for non IQ and non MD
software users. There are no
2 Axis results reported for this
unanalyzed scan.
3
• Press F2 - Auto Analysis.
• Use the arrow keys to move
the neck ROI to the top
(proximal end) of the femoral
neck and properly position:
– It should contain no greater
trochanter. 1
– It should be perpendicular to
the axis of the femoral neck. 2
– It should contain minimal if
any ischium. 3
• Press the Esc key to return
to the Bone Results screen.
The software will correctly
position the neck ROI.
• Neck is the default region for
Esc F2 which results will be printed.
 SAVE DATA AND PRINT
• If no changes need to be
made, or changes are
complete, save the data and
print results.
• If you wish to print a graph of
results for the neck region,
you may use the arrow keys
to highlight the region you
wish to print.
• The default region for a
correctly acquired and
analyzed femur scan is Total.
(Neck for non IQ, MD)
• Press the Esc key to view the
graph.
• Press F1 - Save Changes.
The screen will flash briefly
while changes are saved.
• Press F2 - Print. Type in the
number of copies you wish to
print.
• Press the Esc key twice.
Esc F1F2 • Answer N (no) to prompt to
return to main menu.
 REVIEW:
Essentials for Accurate and Repeatable Results

• Entering Patient Information:

– Search for the patient name, this will prevent multiple entries of a patient
into the database. ENTER A PATIENT INTO A DATABASE ONE TIME.
– Enter information correctly before scanning the patient.
– Enter measured values for the patient’s height and weight.
• Proper Patient Positioning:
– Make sure the patient is centered and square on the table.
– Rotate the patients leg and secure in bracket. Position tissue equivalent
material, if appropriate.
• Correct Scan Mode Selection:
– Measure the thickness of the patient in the region to be scanned. Choose
the correct scan mode accordingly.
 REVIEW, CONTINUED:
Essentials for Accurate and Repeatable Results

• Correct Scan Acquisition:

– Shaft should be centered and straight in the image.
– Scan sufficient shaft before ischium appears.
– Ensure proper femur rotation. Minimal or no lesser trochanter should visible.
– End the scan 25 scan lines above the top of the greater trochanter.
• Correct and Consistent Scan File Analysis:
– Let the computer do the analysis for DPX-IQ and DPX-MD software. Adjust
ROI only if necessary.
– Neck ROI should:
• be perpendicular to the axis of the femoral neck,
• not contain greater trochanter,
• contain minimal or no ishium.
– Save the analysis (even if you do not make any changes) and print.
 AVOID COMMON MISTAKES:
Frequently asked questions.

• Q1: I noticed white in the image, adjacent to the greater trochanter,

while scanning the femur. What might have caused it and will it affect
scan results?
• A1: The white in the image may be due to air being scanned and it
may affect scan results. Check the following:
– Was the shaft of the femur centered in the image at the start of the scan?
If the shaft is not centered, it is possible the scan will include air.
Reposition the scan arm and rescan the patient if this is the case.
– Is the patient very thin in the region you see white? If so, did you place
tissue equivalent material adjacent to the patient as outlined earlier in this
presentation? Place the tissue equivalent bags next to the hip and rescan
the patient if this is the case. (See example to follow.)
 AVOID COMMON MISTAKES:
Example of air in the scan region.

• This example shows air in the scan and incorrect acquisition.

• The scan was not

properly acquired: • Air appears in this
– There is insufficient scan. More air would
tissue acquired above have appeared if the
the top of the greater scan had been allowed
trochanter. to continue the
– There is insufficient appropriate 25 scan
tissue acquired before lines above the greater
the appearance of the trochanter. This may
ischium.
affect BMD and ROI
area values.
 AVOID COMMON MISTAKES:
Frequently asked questions.

• Q2: The software appears to have misplaced the neck ROI. Why isn’t the
software analyzing the scan correctly?
• A2: There may be several explanations, check the following:
– Check that the scan was properly acquired. Monitor the position of the femoral
shaft as the scan is acquired. It should be centered and straight when the scan
begins. There should be NO air in the image. There should be sufficient tissue
acquired before the appearance of the ischium in the image.
– MAKE SURE YOU HAVE CORRECTLY ENTERED THE SIDE YOU WISH TO SCAN,
BEFORE YOU BEGIN THE SCAN.
 AVOID COMMON MISTAKES:
Example of problem scan.
• This scan shows incorrect patient side was entered and improper scan acquisition.
• The right femur was scanned, although “Left”
was entered for patient side.
• The acquisition is incorrect:
– The shaft is not centered in the image.
– There is no tissue seen before the appearance
of the ischium.
• The scan values may be checked
after a scan is acquired. When
analyzing, press F1-Verify Values
and then F1 - Scan Values to view
the values used during a scan.
Here we see the technologist
entered “Left” for patient side.
 AVOID COMMON MISTAKES:
Frequently asked questions.

• Q3: One of the region ROIs does not appear to be the right size. I have made sure the neck
ROI is perpendicular to the axis of the femur, there is no greater trochanter or ischium in the
neck ROI. Is there anything else I may check to determine if the analysis is correct?
• A3: You may check the Area Values of the analyzed ROIs. At the bone results screen, you
may press F4-Change headings to look at additional analysis information including area
values:
– For IQ and MD software: Neck area: 3 - 6 cm2, Ward’s area should be approximately half of the neck value, Troch.
Area: 7 - 17 cm2 (depending on patient size), Total: 24 - 44 cm2 (depending on patient size).
– For all other software versions: Neck area: 3 - 6 cm2, Ward’s area should be approximately half of the neck value,
Troch. Area: 7 - 17 cm2 (depending on patient size).
 AVOID COMMON MISTAKES:
Check additional analysis information.

• Pressing F4 - Change Headings in analysis, will display additional information.

DPX-IQ and DPX-MD software. DPX, DPX-L, DPXA, DPX-alpha software.

Area values fall within the ranges defined.