density allows the assessment of bone
mineral density (BMD) and bone mineral
content (BMC) without interference from
soft tissue. DXA systems can be categorized
as either whole body or peripheral systems
and both rely on the generation of X-rays by a
vacuum tube to provide the energy necessary
to assess bone density. Whole-body systems
make bone density measurements of the
spine and hips, while peripheral systems use
the heel, wrist, or finger to determine bone
density. Peripheral systems, because of the
smaller body parts they scan, are generally
smaller than whole body systems and
oftentimes mobile.
DXA systems use one of two methods to
generate X-rays of two different energy levels.
The first method applies alternating pulses of
high and low voltage to an X-ray tube. This
causes the tube to produce X-rays of two
distinctly different energy levels. The other
method uses a single potential source but
employs a K-edge or compound filter to split
the output into high and low energy levels.
These X-rays are collimated down to a
pencil-thin beam (first-generation systems)
or a broad beam (second-generation systems)
that scans bones. Because of the beam shape,
first-generation systems require multiple
passes over the bones while second-generation
systems require only one pass.
On the opposite side of the body part of
interest and across from the X-ray source, is
either a single detector (first generation) or an
array of detectors (second generation) that are
similar to those found on X-ray phototimers.
These detectors contain filtration to make
them energy sensitive, causing them to
discriminate between the high and low levels
of radiation generated by the alternating
pulses of high and low voltage supplied to the
X-ray tube. A dual-channel analyzer amplifies
the output from both detectors. Both bone
and soft tissue absorb energy from higherintensity
X-rays. However, only the soft tissue
absorbs most of the low energy radiation, its
level is subtracted from the high-energy
radiation level to determine the amount of
X-rays actually absorbed by just the bone. The
system reports this calculated level of BMD in
grams per square centimeter (g/cm2) and
BMC as grams per centimeter (g/cm). Later
systems go a step further, comparing the
patients’ readings to statistical norms and
reporting their bone density as the number of
standard deviations above or (usually) below
the reference adult population.