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The social costs of osteoporosis are huge and keep growing because of increased life expectancy. Although a low bone mineral density is considered to be associated with a higher risk of fracture, densitometry alone has been shown to be inadequate to predict a significant number of fractures, hence the need to develop innovative and inexpensive diagnostic methods to be used together with the consolidated systems. The Bone Structure Index is computed using a patented technique that virtually simulates the application of compressive loads on the trabecular structure’s reconstructions obtained from the patient’s digital radiographs. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. This configuration presents specific advantages but the use of a handheld portable X-ray device requires safety procedures specifically designed to protect the operator and the patient, which are discussed in the present paper.

Densitometry alone has been shown to be inadequate to predict all osteoporotic fractures, since 40-50% occur in people who do not have a low bone density. The BESTEST®, Bone Elastic Structure Test, virtually simulates compressive loads on the trabecular architecture’s reconstructions obtained from digital radiographs of first proximal epiphyses of the non-dominant hand. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. While in certain cases these systems present risks that are no greater than with standard systems, issues related to: (i) position of the handheld X-ray device relative to the operator, (ii) risk of misalignment of the X-ray units during exposure, (iii) patient protection and (iv) correct positioning of the sensor must still be addressed. A special stand and a customized sensor holder have been therefore designed, so that safety for patient and operator and repeatability of the exam have been improved.