Journal of Sports Science and Medicine
Journal of Sports Science and Medicine
ISSN: 1303 - 2968   
Ios-APP Journal of Sports Science and Medicine
Androit-APP Journal of Sports Science and Medicine
©Journal of Sports Science and Medicine (2015) 14, 620 - 626

Research article
Segmental Musculoskeletal Examinations using Dual-Energy X-Ray Absorptiometry (DXA): Positioning and Analysis Considerations
Nicolas H. Hart1,2, , Sophia Nimphius3, Tania Spiteri3, Jodie L. Cochrane3, Robert U. Newton1
Author Information
1 ECU Health and Wellness Institute, Edith Cowan University, Perth, W.A., Australia
2 Fremantle Dockers Football Club, Perth, W.A., Australia
3 Centre for Exercise and Sport Science Research, Edith Cowan University, Perth, W.A., Australia

Nicolas H. Hart
✉ Building 21, Room 222, ECU Health & Wellness Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia, Australia – 6027
Publish Date
Received: 27-05-2015
Accepted: 17-06-2015
Published (online): 11-08-2015
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Musculoskeletal examinations provide informative and valuable quantitative insight into muscle and bone health. DXA is one mainstream tool used to accurately and reliably determine body composition components and bone mass characteristics in-vivo. Presently, whole body scan models separate the body into axial and appendicular regions, however there is a need for localised appendicular segmentation models to further examine regions of interest within the upper and lower extremities. Similarly, inconsistencies pertaining to patient positioning exist in the literature which influence measurement precision and analysis outcomes highlighting a need for standardised procedure. This paper provides standardised and reproducible: 1) positioning and analysis procedures using DXA and 2) reliable segmental examinations through descriptive appendicular boundaries. Whole-body scans were performed on forty-six (n = 46) football athletes (age: 22.9 ± 4.3 yrs; height: 1.85 ± 0.07 cm; weight: 87.4 ± 10.3 kg; body fat: 11.4 ± 4.5 %) using DXA. All segments across all scans were analysed three times by the main investigator on three separate days, and by three independent investigators a week following the original analysis. To examine intra-rater and inter-rater, between day and researcher reliability, coefficients of variation (CV) and intraclass correlation coefficients (ICC) were determined. Positioning and segmental analysis procedures presented in this study produced very high, nearly perfect intra-tester (CV ≤ 2.0%; ICC ≥ 0.988) and inter-tester (CV ≤ 2.4%; ICC ≥ 0.980) reliability, demonstrating excellent reproducibility within and between practitioners. Standardised examinations of axial and appendicular segments are necessary. Future studies aiming to quantify and report segmental analyses of the upper- and lower-body musculoskeletal properties using whole-body DXA scans are encouraged to use the patient positioning and image analysis procedures outlined in this paper.

Key words: Segmentation, muscle, bone, standardisation, composition, regional, method

           Key Points
  • Musculoskeletal examinations using DXA technology require highly standardised and reproducible patient positioning and image analysis procedures to accurately measure and monitor axial, appendicular and segmental regions of interest.
  • Internal rotation and fixation of the lower-limbs is strongly recommended during whole-body DXA scans to prevent undesired movement, improve frontal mass accessibility and enhance ankle joint visibility during scan performance and analysis.
  • Appendicular segmental analyses using whole-body DXA scans are highly reliable for all regional upper-body and lower-body segmentations, with hard-tissue (CV ≤ 1.5%; ≥ 0.990) achieving greater reliability and lower error than soft-tissue (CV ≤ 2.4%; ≥ 0.980) masses when using our appendicular segmental boundaries.
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