Effect of Calcium Tablets on Interpretation of Lumbar Spine DXA Scans

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Effect of Calcium Tablets on Interpretation of Lumbar Spine DXA Scans David L. Kendler, Gary M. Kiebzak, Catherine G. Ambrose, C. Dinu, Stephen Robertson, Peg Schmeer, Janet L. Van Pelt Journal of Clinical Densitometry Volume 9, Issue 1, Pages 97-104 (January 2006) DOI: 10.1016/j.jocd.2005.12.002 Copyright © 2006 The International Society for Clinical Densitometry Terms and Conditions

Fig. 1 Image of GE Lunar Prodigy aluminum spine phantom with 200-mg calcium tablets overlapping the neutral and soft-tissue fields. (A) The EnCore software eliminated tablet pixels from the analysis by mapping tablets (four green oval-shaped objects) as artifact. Neutral field is seen as the green-shaded zones. (B) Tablets (four white oval-shaped objects) shown to be distinct from the green soft-tissue field. Journal of Clinical Densitometry 2006 9, 97-104DOI: (10.1016/j.jocd.2005.12.002) Copyright © 2006 The International Society for Clinical Densitometry Terms and Conditions

Fig. 2 Examples of GE Lunar Prodigy lumbar spine images with calcium (Ca) tablets taped to the skin of a volunteer. (A) One 500-mg Ca tablet (bottom arrow) mapped partly as artifact and (B) partly as soft-tissue (green field) possibly due to differential density of the tablet itself, being more dense in the center than the edges. (C) Two 200-mg Ca tablets (arrows) totally and partly overlying bone. When totally overlying bone, the tablet (circled) is considered to be bone, although is visible to the technologist and can be manually deleted from the analysis or, the entire vertebral body can be excluded from analysis. The tablet partly overlying bone (top arrow) interferes with proper edge detection; the tablet is mapped partly as bone (green projection from edge of vertebral body, right side of image) and partly as neutral field (tablet appears as grayish-white oval-shaped object at tip of top arrow). (D) Neutral field shaded green, includes part of Ca tablet as explained in Fig. 2C. Journal of Clinical Densitometry 2006 9, 97-104DOI: (10.1016/j.jocd.2005.12.002) Copyright © 2006 The International Society for Clinical Densitometry Terms and Conditions

Fig. 3 Tracking a paraffin-coated calcium (Ca) tablet through the gastrointestinal tract using a Hologic Delphi W (array mode). (A) 2.5 min postingestion. Swallowed tablet not yet visible in lumbar spine field. (B) 8.5 min postingestion. Tablet overlying bone (L3) and manually excluded from the calculation of bone mineral density (BMD). (C) 10 min postingestion. Ca tablet in soft-tissue field. See also Table 4. Journal of Clinical Densitometry 2006 9, 97-104DOI: (10.1016/j.jocd.2005.12.002) Copyright © 2006 The International Society for Clinical Densitometry Terms and Conditions