QUS measurements were performed with a Lunar Achilles Insight (TM Insight GE Healthcare, Milwaukee, WI, USA). This portable device measured bone stiffness using ultrasound waves, and measurements were always taken following manufacturer guidelines and by trained staff. QUS is considered a reliable, valid and radiation-free method to assess bone health in children [33 (link)].
Lunar achilles insight
Manufactured by GE Healthcare
Sourced in United States
The Lunar Achilles Insight is a bone densitometry system designed to measure bone mineral density (BMD) and assess osteoporosis risk. The device uses ultrasound technology to evaluate the bone status of patients.
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11 protocols using lunar achilles insight
1
Ultrasound-Based Bone Health Assessment
2
Ultrasound Assessment of Calcaneal Bone
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A water-bath ultrasound system which generates a band of frequencies from 200 to 600 kHz (Lunar Achilles Insight™ - GE Healthcare) was used for measurements of SI in the calcaneoual region of the independent foot. Both SI (automatically calculated from broadband ultrasound attenuation and the speed of sound) and T-score were recorded using a standard protocol supplied by the manufacturer. Data collection was obtained after quality control was carried out using the quality phantom. Precision and reliability of the technique were examined by repeating the measurements on 20 subjects in three consecutive days.
3
Calcaneal Quantitative Ultrasound Assessment
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Calcaneal QUS (Lunar Achilles Insight, GE Healthcare, Milwaukee, WI, USA) was performed in all participants to assess speed of sound (SOS), broadband ultrasound attenuation (BUA) and bone stiffness index (SI). SOS, a measure of the ultrasound velocity inside the bone, describes the stiffness of a material by the ratio of the traversed distance to the transit time, in meters per second. BUA reflects the absorption of sound waves and is expressed as decibels per megahertz. SOS is in comparison to BUA a predictor of mechanical properties and therefore of bone strength in trabecular bone [29 (link),30 (link)]. SI is calculated by a linear combination of BUA and SOS as (0.67 × BUA) + (0.28 × SOS) − 420 [31 (link),32 (link)]. A detailed description is available [2 (link),33 (link)]. Due to different registration settings of the QUS devices, BUA and SOS values were not available for all participants (BUA: n = 2258, SOS; n = 2263, and SI: n = 4340). A comparability study of five QUS devices used within the IDEFICS study was conducted on 91 subjects performing three repeated measurements per foot and device, revealing a significant deviation of the SI-values between the devices varying within a range of 0 to 5 SI units in average. Multiple multilevel regression analysis was used to control for the cluster design and considering that in each country a different device was used.
4
Quantitative Ultrasound Measurements of Calcaneus
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Quantitative ultrasound (Lunar Achilles Insight, GE Medical Systems) was used to measure the speed of sound (metres per second) and broadband ultrasound attenuation (decibels per megahertz) of the heel. In cases of a previous fracture within the lower extremity, only the opposite calcaneus was measured. T-score was derived from the value of broadband ultrasound attenuation and expressed as the number of SDs from the mean value of a control gender-matched population [22 (link)]. The T-scores are reported as the number of standard deviations below the young adult mean (normal, > -1; osteopaenia, -1 to -2.49; osteoporosis, ≤ -2.5) [22 (link)]. The device was calibrated daily in accordance with the manufacturer’s recommendations. The same operator took all the measurements. Short-term in vivo precision was established on the basis of repeated measurements in 10 healthy women. The coefficient of variation (CV%) was calculated using the following formula: CV% _ (SD/mean) 100; the percentage value was: 4% for broadband ultrasound attenuation and 1.2% for speed of sound.
5
Calcaneal Ultrasound Bone Assessment
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QUS of the calcaneus was performed using GE Medical systems Lunar Achilles Insight. The device provides measures of the velocity and frequency attenuation of the sound wave propagation through bone. The measures are termed “speed of sound” (SOS) and “broad band ultrasound attenuation” (BUA). The device also provides a combination of SOS and BUA, called stiffness index (SI) with the associated T-score of the calcaneus. The T-score was derived from the manufacturer reference database, and provided by the device.
6
Measuring Bone Density with QUS
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The bone density was measured using QUS densitometry. All participants underwent calcaneal QUS using a Lunar Achilles Insight bone densitometer (GE Healthcare, Milwaukee, WI, USA). The patients were categorized as normal (T-score > −1.0), osteopenia (T-score = −1 to −2.5), or osteoporosis (T-score < −2.5) based on the World Health Organization (WHO) criteria.
7
Quantitative Ultrasound for Bone Health Assessment
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Bone status was measured on the right calcaneus using Lunar Achilles Insight (GE Healthcare, Milwaukee, WI, USA). This noninvasive, radiation-free quantitative ultrasonometry (QUS) method was developed to assess bone mineral status in peripheral skeletal sites. Correlations between the stiffness index (SI), the bone mineral density, and content measured by dual energy X-ray absorptiometry have been reported in children and adolescents [19 (link)]. Thus, the SI is a suitable QUS parameter to analyze bone health. The SI is calculated by the raw parameters of broadband ultrasound attenuation and the speed of sound and indicates bone trabecular complexity, architecture, and elasticity. Better bone structure absorbs more sound waves, resulting in higher SI values.
The SI value indicates bone stiffness, so a higher SI is related to better bone health. We used Z-scores based on the SI as a basis for classifying bone health into three groups: normal (Z-score > −1), osteopenia (Z-score = −1–−2.5), and osteoporosis (Z-score <−2.5).
Before each screening session, the bone densitometer was calibrated according to the manufacturer’s standard procedures, and all measurements were performed per the manufacturer’s recommendations.
The SI value indicates bone stiffness, so a higher SI is related to better bone health. We used Z-scores based on the SI as a basis for classifying bone health into three groups: normal (Z-score > −1), osteopenia (Z-score = −1–−2.5), and osteoporosis (Z-score <−2.5).
Before each screening session, the bone densitometer was calibrated according to the manufacturer’s standard procedures, and all measurements were performed per the manufacturer’s recommendations.
8
Quantitative Ultrasound Heel Bone Density Measurement
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BMD measurements were performed on one heel for all women with the quantitative ultrasound (QUS) technique using Lunar Achilles Insight TM—GE Healthcare, which is a heel water-bath ultrasound system. The heel of the independent foot was placed between two ultrasonic transducers in a water bath at 37 °C. The ultrasound generates high-frequency sound waves to measure the heel BMD. T-scores and Z-scores were recorded using the manufacturer reference range after entering the subject’s age into the machine software, which would then match the T- and Z-score results according to age. Measurement results were displayed as a standard BMD fracture risk colored graph, and the stored and absolute values were printed. Daily quality assurance was carried out using the quality phantom. Due to the participants’ young age, we considered Z-score >−2 to be normal. We also used T-scores to assess bone mineral density, and we categorized T-scores into three categories: >−1, (−1–2.5), and <−2.5 [19 ].
9
Quantitative Ultrasound Heel Bone Density Measurement
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BMD measurements were performed on one heel for all women with the quantitative ultrasound (QUS) technique using Lunar Achilles Insight TM—GE Healthcare, which is a heel water-bath ultrasound system. The heel of the independent foot was placed between two ultrasonic transducers in a water bath at 37 °C. The ultrasound generates high-frequency sound waves to measure the heel BMD. T-scores and Z-scores were recorded using the manufacturer reference range after entering the subject’s age into the machine software, which would then match the T- and Z-score results according to age. Measurement results were displayed as a standard BMD fracture risk colored graph, and the stored and absolute values were printed. Daily quality assurance was carried out using the quality phantom. Due to the participants’ young age, we considered Z-score >−2 to be normal. We also used T-scores to assess bone mineral density, and we categorized T-scores into three categories: >−1, (−1–2.5), and <−2.5 [19 ].
10
Quantitative Ultrasound Measurements in Children
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QUS measurements were performed with a Lunar Achilles Insight (TM Insight; GE Healthcare, Milwaukee, WI) and the OsteoReport PC (software version 5.x+; GE Healthcare). The QUS uses ultrasound waves to measure the BUA and the SOS. The SI is then calculated by a linear combination of BUA and SOS as follows: SI = (0.67 ×BUA) + (0.28 × SOS) -420. The same device was used throughout the study, and the calibration was carried out prior to each visit, as in DXA. A standard procedure was followed according to the manufacturer's recommendations. All measurements were performed and analyzed by the same trained researcher. Participants were placed on a stable chair in a comfortable position directly in front of the Achilles device. The position of the leg rested lightly against the calf support, so the foot, calf, and thigh aligned with the center of the calf support and the positioner. Both feet were measured twice in the same session (right, left, right, left), and the mean was used for statistical analyses. The precision data for QUS in children have been reported as 0.2% for SOS, 1.5% for BUA, and 1.8% for stiffness (13) (link).
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