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European semi-anthropomorphic spine phantom for the calibration of bone densitometers: Assessment of precision, stability and accuracy the European quantitation of osteoporosis study group

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Abstract

Up to now it has not been possible to reliably cross-calibrate dual-energy X-ray absorptiometry (DXA) densitometry equipment made by different manufacturers so that a measurement made on an individual subject can be expressed in the units used with a different type of machine. Manufacturers have adopted various procedures for edge detection and calibration, producing various normal ranges which are specific to each individual manufacturer's brand of machine. In this study we have used the recently described European Spine Phantom (ESP, prototype version), which contains three semi-anthropomorphic “vertebrae” of different densities made of simulated cortical and trabecular bone, to calibrate a range of DXA densitometers and quantitative computed tomography (QCT) equipment used in the measurement of trabecular bone density of the lumbar vertebrae. Three brands of QCT equipment and three brands of DXA equipment were assessed. Repeat measurements were made to assess machine stability. With the large majority of machines which proved stable, mean values were obtained for the measured low, medium and high density vertebrae respectively. In the case of the QCT equipment these means were for the trabecular bone density, and in the case of the DXA equipment for vertebral body bone density in the posteroanterior projection. All DXA machines overestimated the projected area of the vertebral bodies by incorporating variable amounts of transverse process. In general, the QCT equipment gave measured values which were close to the specified values for trabecular density, but there were substantial differences from the specified values in the results provided by the three DXA brands. For the QCT and Norland DXA machines (posteroanterior view), the relationships between specified densities and observed densities were found to be linear, whereas for the other DXA equipment (posteroanterior view), slightly curvilinear, exponential fits were found to be necessary to fit the plots of observed versus specified densities. From these plots, individual calibration equations were derived for each machine studied. For optimal cross-calibration, it was found to be necessary to use an individual calibration equation for each machine. This study has shown that it is possible to cross-calibrate DXA as well as QCT equipment for the measurement of axial bone density. This will be of considerable benefit for large-scale epidemiological studies as well as for multi-site clinical studies depending on bone densitometry.

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Authors and Affiliations

  1. MRC Clinical Research Centre and Northwick Park Hospital, Harrow, UK

    J. Pearson, M. Henley, J. Bright & J. Reeve

  2. Arthritic and Metabolic Bone Disease Research Unit, K.U. Leuven, Pellenberg, Belgium

    J. Dequeker

  3. Siemens Medical Systems, Erlangen, Germany

    W. Kalender

  4. INSERM 18, Paris, France

    A. M. Laval-Jeantet

  5. Institut für Biomedizinische Technik, Universität and ETH Zurich, Zurich, Switzerland

    P. Rüegsegger

  6. Klinik Steglitz, Freie Universität Berlin, Berlin, Germany

    D. Felsenberg

  7. Department of Diagnostic Radiology, University of Manchester, Manchester, UK

    J. Adams

  8. Department of Medicine III, University Hospital Rotterdam, Rotterdam, The Netherlands

    J. C. Birkenhäger

  9. Centre d'Absorptiometrike Osseuse, Hôpital E. Herriot, Lyon, France

    P. Braillon

  10. Fundacion Jimenez Diaz, Madrid, Spain

    M. Diaz Curiel

  11. Zentrum für Radiologie, Kassel Städtische Kliniken, Kassel, Germany

    M. Fischer

  12. Departamento de Medicina, Hospital Universitario, Seville, Spain

    F. Galan

  13. Arthritic and Metabolic Bone Disease Research Unit, K.U. Leuven, Pellenberg, Belgium

    P. Geusens

  14. Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark

    L. Hyldstrup

  15. Department of Diagnostic Radiology, University of Bern, Bern, Switzerland

    P. Jaeger

  16. Radiation Physics Section, Kliniskt Fysiologiska avd. Norra Alvsborgs Länssjnkhus, Trollhattan, Sweden

    R. Jonson

  17. Medical Physics Laboratory, University of Ioannina, Greece

    J. Kalef-Ezras

  18. Hôpital Lapeyronie, Université de Montpellier, Montpellier, France

    P. Kotzki

  19. Department of Surgery, Kuopio University Central Hospital, Kuopio, Finland

    H. Kröger

  20. Department of Endocrinology, Academisch Ziekenhuis Vrije Universitat Amsterdam, Amsterdam, The Netherlands

    A. van Lingen

  21. Department of Diagnostic Radiology, University of Uppsala, Uppsala, Sweden

    S. Nilsson

  22. Department of Radiology, Akademisch Ziekenhuis, Vrije Universitat Brussells, Brussels, Belgium

    M. Osteaux

  23. Departamento de Medicina, University Hospital ‘Virgin Macaren’, Seville, Spain

    R. Perez Cano

  24. Grampian Health Board, Geriatric and Specialist Services, Aberdeen, UK

    D. M. Reid

  25. Radiologisches Zentrum, Universitätsklinikum Essen, Essen, Germany

    C. Reiners

  26. U.F. Maladies Osseuses et Metaboliques, C.H.U. Purpan Service d'Endocrinologie, Toulouse, France

    C. Ribot

  27. Klinik und Poliklinik für Nuklearmedizin, Würzburg, Germany

    P. Schneider & G. Wittenberg

  28. Division of Clinical Pathophysiology, University Hospital Geneva, Geneva, Switzerland

    D. O. Slosman

Authors
  1. J. Pearson
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  2. J. Dequeker
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  3. M. Henley
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  4. J. Bright
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  5. J. Reeve
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  6. W. Kalender
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  7. A. M. Laval-Jeantet
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  8. P. Rüegsegger
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  9. D. Felsenberg
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  10. J. Adams
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  11. J. C. Birkenhäger
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  12. P. Braillon
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  13. M. Diaz Curiel
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  14. M. Fischer
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  15. F. Galan
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  16. P. Geusens
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  17. L. Hyldstrup
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  18. P. Jaeger
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  19. R. Jonson
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  20. J. Kalef-Ezras
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  21. P. Kotzki
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  22. H. Kröger
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  23. A. van Lingen
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  24. S. Nilsson
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  25. M. Osteaux
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  26. R. Perez Cano
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  27. D. M. Reid
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  28. C. Reiners
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  29. C. Ribot
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  30. P. Schneider
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  31. D. O. Slosman
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  32. G. Wittenberg
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Additional information

A Concerted Action of the European Community's COMAC-BME programme 1989–92. For further details of the Study Group see Appendix.

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Pearson, J., Dequeker, J., Henley, M. et al. European semi-anthropomorphic spine phantom for the calibration of bone densitometers: Assessment of precision, stability and accuracy the European quantitation of osteoporosis study group. Osteoporosis Int 5, 174–184 (1995). https://doi.org/10.1007/BF02106097

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  • DOI: https://doi.org/10.1007/BF02106097

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