Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results

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Genant, Harry K.¹; Grampp, Stephan¹; Glüer, Claus C.¹; Faulkner, Kenneth G.¹; Jergas, Michael¹; Engelke, Klaus¹; Hagiwara, Satoshi¹; Kuijk, Cornelis van¹

Universal standardization for dual x-ray absorptiometry: patient and phantom cross-calibration results

J Bone Miner Res. October 1994;9(10):1503-1514

©1994 American Society for Bone and Mineral Research

Affiliations

¹Musculoskeletal Section, Department of Radiology, University of California, San Francisco
Abstract

The comparison of patient data among different dual x-ray absorptiometry (DXA) scanners is complicated because no universally accepted cross-calibration procedure or standard currently exists. This study was performed under the auspices of the International DXA Standardization Committee to establish appropriate cross-calibration parameters. Posteroanterior (PA) lumbar spine measurements of 100 women, ages 20–80 years (mean 52.6 + 16, range of BMD = 0.4–1.6 g/cm²) were obtained on a Norland XR26 Mark II, a Lunar DPX-L, and a Hologic QDR 2000 densitometer using standard procedures (pencil beam mode for all three scanners). Area, BMC, and BMD results from the different scanners were compared for all patients. In addition, the European spine phantom (ESP) and the European spine phantom prototype (ESP prototype), as well as standard phantoms from all three manufacturers, were evaluated on the three systems. To achieve universal scanner calibration, we used the intercept and slope of the patient's correlations and the value of the middle vertebra of the ESP as a reference point in a series of standardization formulas, and we have expressed the results as sBMD (mg/cm²). The correlations of the patients' spinal BMD values were excellent for each of the three scanner pairs. The average absolute difference in patient spinal BMD values (L2–4) between Hologic and Norland was 0.012 g/cm² (1.3%); it was 0.113 g/cm² (11.7%) between Hologic and Lunar and 0.118 g/cm² (12.2%) between Norland and Lunar. The phantoms' regression lines approximated those of the patient regression lines, and the phantoms with only one measurement point were very close to the patients' regression lines. After applying the standardization formulas, the average absolute differences for the 100 patients were 28 mg/cm² (2.7%) for Hologic/Norland, 23 mg/cm² (2.2%) for Hologic/Lunar, and 29 mg/cm² (2.8%) for Norland/Lunar. Average BMD results for the patients before correction were 0.972 g/cm² for Hologic, 1.100 g/cm² for Lunar, and 0.969 g/cm² for Norland. After correction, sBMD results for patients were 1045 mg/cm² for Hologic, 1047 mg/cm² for Lunar, and 1043 mg/cm² for Norland. The standardization approach as performed in our study provided compatibility of DXA results obtained on different scanners.
Links

DOI: 10.1002/jbmr.5650091002

PubMed: 7817795

WoS: A1994PJ11100001
History

Received: 1994-01-13

Revised: 1994-04-07

Accepted: 1994-04-09

Cited Works (3)

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1995	Looker AC, Johnston CC Jr, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Lindsay RL. Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res. May 1995;10(5):796-802.
1996	Genant HK, Engelke K, Fuerst T, Glüer C, Grampp S, Harris ST, Jergas M, Lang T, Lu Y, Majumdar S, Mathur A, Takada M. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res. June 1996;11(6):707-730.
1998	De Laet CEDH, Van Hout BA, Burger H, Weel AEAM, Hofman A, Pols HAP. Hip fracture prediction in elderly men and women: validation in the rotterdam study. J Bone Miner Res. October 1998;13(10):1587-1593.
2000	Faulkner KG. Bone matters: are density increases necessary to reduce fracture risk? J Bone Miner Res. February 2000;15(2):183-187.
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2003	Eastell R, Barton I, Hannon R, Chines A, Garnero P, Delmas P. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res. June 2003;18(6):1051-1056.
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