Osteoporosis International

, Volume 23, Issue 7, pp 1977–1985 | Cite as

Assessment of technical and biological parameters of volumetric quantitative computed tomography of the foot: a phantom study

  • K. E. SmithEmail author
  • B. R. Whiting
  • G. G. Reiker
  • P. K. Commean
  • D. R. Sinacore
  • F. W. Prior
Original Article



Few studies exist for bone densitometry of the whole foot. A phantom study demonstrated the sources of error and necessary controls for accurate quantitative computed tomography of the foot. A loss in bone mineral density (BMD) in the small foot bones may be an early indicator of diabetic foot complications.


Volumetric quantitative computed tomography (vQCT) facilitates the assessment of pedal bone osteopenia, which, in the presence of peripheral neuropathy, may well be an early sign of diabetic foot deformity. To date, sources and magnitudes of error in foot vQCT measurements have not been reported.


Foot phantoms were scanned using a 64-slice CT scanner. Energy (in kilovoltage peak), table height, phantom size and orientation, location of “bone” inserts, insert material, location of calibration phantom, and reconstruction kernel were systematically varied during scan acquisition.


Energy (in kilovoltage peak) and distance from the isocenter (table height) resulted in relative attenuation changes from −5% to 22% and −5% to 0%, respectively, and average BMD changes from −0.9% to 0.0% and −1.1% to 0.3%, respectively, compared to a baseline 120-kVp scan performed at the isocenter. BMD compared to manufacturer-specified values ranged, on average, from −2.2% to 0.9%. Phantom size and location of bone-equivalent material inserts resulted in relative attenuation changes of −1.2% to 1.4% compared to the medium-sized phantom.


This study demonstrated that variations in kilovoltage peak and table height can be controlled using a calibration phantom scanned at the same energy and height as a foot phantom; however, error due to soft tissue thickness and location of bones within a foot cannot be controlled using a calibration phantom alone.


Bone mineral density Diabetes Foot Neuropathic Charcot’s arthropathy Phantom Quantitative computed tomography 



Funding for this project was provided by the National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases (1 R21 DK079457-03). We thank Tim Street, CT technologist within the Clinical Center for Imaging Research (CCIR) for his help with CT image acquisition for this project. The CCIR is supported in part by the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) (1 UL1 RR024992-01). We also thank Dr. Charles Hildebolt for the statistical assistance.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • K. E. Smith
    • 1
    Email author
  • B. R. Whiting
    • 2
  • G. G. Reiker
    • 1
  • P. K. Commean
    • 1
  • D. R. Sinacore
    • 3
  • F. W. Prior
    • 1
  1. 1.Electronic Radiology Laboratory, Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  2. 2.Department of RadiologyUniversity of PittsburghPittsburghUSA
  3. 3.Applied Kinesiology Laboratory, Program in Physical TherapyWashington University School of MedicineSt. LouisUSA

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