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

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

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

References

  1. 1.
    Sohn MW, Stuck RM, Pinzur M, Lee TA, Budiman-Mak E (2010) Lower-extremity amputation risk after Charcot arthropathy and diabetic foot ulcer. Diabetes Care 33(1):98–100PubMedCrossRefGoogle Scholar
  2. 2.
    Sinacore DR, Hastings MK, Bohnert KL, Fielder FA, Villareal DT, Blair VP 3rd, Johnson JE (2008) Inflammatory osteolysis in diabetic neuropathic (Charcot) arthropathies of the foot. Phys Ther 88(11):1399–1407PubMedCrossRefGoogle Scholar
  3. 3.
    Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S (2002) Charcot neuroarthropathy in diabetes mellitus. Diabetologia 45(8):1085–1096PubMedCrossRefGoogle Scholar
  4. 4.
    Brodsky JW (1993) The diabetic foot. Surgery of the foot and ankle, 6th edn. Mosby Year Book, St. LouisGoogle Scholar
  5. 5.
    Schon LC, Weinfeld SB, Horton GA, Resch S (1998) Radiographic and clinical classification of acquired midtarsus deformities. Foot Ankle Int 19(6):394–404PubMedGoogle Scholar
  6. 6.
    Chantelau E, Kimmerle R, Poll LW (2007) Nonoperative treatment of neuro-osteoarthropathy of the foot: do we need new criteria? Clin Podiatr Med Surg 24(3):483–503, ixPubMedCrossRefGoogle Scholar
  7. 7.
    Genant HK, Ettinger B, Cann CE, Reiser U, Gordan GS, Kolb FO (1985) Osteoporosis: assessment by quantitative computed tomography. Orthop Clin North Am 16(3):557–568PubMedGoogle Scholar
  8. 8.
    Gluer CC, Reiser UJ, Davis CA, Rutt BK, Genant HK (1988) Vertebral mineral determination by quantitative computed tomography (QCT): accuracy of single and dual energy measurements. J Comput Assist Tomogr 12(2):242–258PubMedCrossRefGoogle Scholar
  9. 9.
    Lang TF, Augat P, Lane NE, Genant HK (1998) Trochanteric hip fracture: strong association with spinal trabecular bone mineral density measured with quantitative CT. Radiology 209(2):525–530PubMedGoogle Scholar
  10. 10.
    Hounsfield GN (1980) Nobel Award address. Computed medical imaging. Med Phys 7(4):283–290PubMedCrossRefGoogle Scholar
  11. 11.
    Cann CE, Genant HK (1980) Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr 4(4):493–500PubMedCrossRefGoogle Scholar
  12. 12.
    Kalender WA (1992) A phantom for standardization and quality control in spinal bone mineral measurements by QCT and DXA: design considerations and specifications. Med Phys 19(3):583–586PubMedCrossRefGoogle Scholar
  13. 13.
    Robb RA (2001) The biomedical imaging resource at Mayo Clinic. IEEE Trans Med Imaging 20(9):854–867PubMedCrossRefGoogle Scholar
  14. 14.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedCrossRefGoogle Scholar
  15. 15.
    Boone JM (2010) Method for evaluating bow tie filter angle-dependent attenuation in CT: theory and simulation results. Med Phys 37(1):40–48PubMedCrossRefGoogle Scholar
  16. 16.
    Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, Felsenberg D, Ito M, Prevrhal S, Hans DB, Lewiecki EM (2008) Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 11(1):123–162PubMedCrossRefGoogle Scholar
  17. 17.
    Griffith JF, Genant HK (2008) Bone mass and architecture determination: state of the art. Best Pract Res Clin Endocrinol Metab 22(5):737–764PubMedCrossRefGoogle Scholar
  18. 18.
    Bolotin HH (2007) DXA in vivo BMD methodology: an erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling. Bone 41(1):138–154PubMedCrossRefGoogle Scholar
  19. 19.
    Bligh M, Bidaut L, White RA, Murphy WA Jr, Stevens DM, Cody DD (2009) Helical multidetector row quantitative computed tomography (QCT) precision. Acad Radiol 16(2):150–159PubMedCrossRefGoogle Scholar
  20. 20.
    Hangartner TN, Short DF (2007) Accurate quantification of width and density of bone structures by computed tomography. Med Phys 34(10):3777–3784PubMedCrossRefGoogle Scholar
  21. 21.
    Bousson V, Le Bras A, Roqueplan F, Kang Y, Mitton D, Kolta S, Bergot C, Skalli W, Vicaut E, Kalender W, Engelke K, Laredo JD (2006) Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone. Osteoporos Int 17:855–864PubMedCrossRefGoogle Scholar
  22. 22.
    Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN (2009) Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am 91(8):1882–1889PubMedCrossRefGoogle Scholar
  23. 23.
    Tanaka C, Ueguchi T, Shimosegawa E, Sasaki N, Johkoh T, Nakamura H, Hatazawa J (2006) Effect of CT acquisition parameters in the detection of subtle hypoattenuation in acute cerebral infarction: a phantom study. AJNR Am J Neuroradiol 27(1):40–45PubMedGoogle Scholar
  24. 24.
    Zerhouni EA, Boukadoum M, Siddiky MA, Newbold JM, Stone DC, Shirey MP, Spivey JF, Hesselman CW, Leo FP, Stitik FP et al (1983) A standard phantom for quantitative CT analysis of pulmonary nodules. Radiology 149(3):767–773PubMedGoogle Scholar
  25. 25.
    Prior F, Commean P, Ju T, Hastings M, Hildebolt C, Sinacore D (2007) Developing a biomarker for neuropathic arthropathy in diabetic patients. In: Xplore I Life Science Systems and Applications Workshop, Bethesda, MD, pp 13–16Google Scholar
  26. 26.
    Commean PK, Kennedy JA, Bahow KA, Hildebolt CF, Liu L, Smith KE, Hastings MK, Ju T, Prior FW, Sinacore DR (2011) Volumetric quantitative computed tomography measurement precision for volumes and densities of tarsal and metatarsal bones. J Clin Densitom 14:313–320PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • K. E. Smith
    • 1
  • 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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