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Calcified Tissue International

, Volume 76, Issue 5, pp 348–354 | Cite as

Towards Standardization of Dual X-ray Absorptiometry (DXA) at the Forearm

A Common Region of Interest (ROI) Improves the Comparability among DXA Devices
  • S. Prevrhal
  • Y. Lu
  • H. K. Genant
  • J. O. Toschke
  • J. A. Shepherd
Article

Abstract

Manufacturer-implemented regions of interest (ROIs) to determine the bone mineral density (BMD) at the forearm are currently not standardized across dual X-ray absorptiometry (DXA) devices. We hypothesized that their differences introduce considerable variation in measurement results for forearm BMD when taken on different devices, and that a ROIs common to all devices with standardized placement and size significantly improve device comparability. The common ROI was defined to have a fixed length of 2 cm and to extend proximally from the location where the ulna and radius bones superimpose on the DXA image. The effects of universal standardization of forearm BMD were combined with and compared to those of the common ROI. They were drawn on 91 female study participants (ages 20–80 years, 10 per decade) who were scanned on Hologic QDR-4500, Aloka DCS-600EX, GE Lunar PIXI and Norland pDEXA DXA scanners. For all device combinations, manufacturer-implemented ROI root mean-square errors were significantly higher than for the common ROI, suggesting that implementing an ROI with common design on all scanners is a good way to reduce interdevice variability. When manufacturer-implemented ROIs were universally standardized root mean-square error (RMSE) values were less different from that of the nonstandardized Common ROI, suggesting that universal standardization can further improve interdevice comparability even when a common ROI such as the one implemented here is used. ROI standardization dramatically improves interdevice comparability.

Keywords

Bone densitometry Forearm Standardization Regions of interest 

Notes

Acknowledgments

Thanks to Vesta March and Fay Wong for acquiring the scans and David Breazeale for editing. The International Standards Committee for Bone Measurement (ISCBM) commissioned this study. Each of the manufacturers that participated contributed financially in equal amounts to cover the expense of recruitment, scanning, and data analysis. The participating members of the Forearm Subcommittee of the ISCBM at the time of this study are as listed:
.

.

Name

Institute

City

State

Country

Klaus Engelke

Institute of Medical Physics (IMP)

Erlangen

 

Germany

Harry Genant

OARG/UCSF

San Francisco

CA

USA

Nicole Hamilton

Schick Technologies, Inc.

Long Island

NY

USA

Thomas Hangartner

Wright State University

Dayton

OH

USA

Lewis Harrold

Norland Medical Systems

Fort Atkinson

WI

USA

Willi Kalender

Institute of Medical Physics, University of Erlangen/Nürnberg

Erlangen

 

Germany

RussNord

Lunar/GE

Madison

WI

USA

Svenn Poulsen

Pronosco

Vedbaek

 

Denmark

P. Rüegsegger

Inst. für Biomedizinische Technik

Zürich

 

Switzerland

John Shepherd

OARG/Department of Radiology

San Francisco

CA

USA

Toshiaki Tamegai

Aloka Co., Ltd.

Tokyo

 

Japan

George Tysarczyk-Niemeyer

Stratec Medizintechnik GmbH

Pforzheim

 

Germany

Eric von Stetten

Hologic, Inc.

Bedford

MA

USA

Christian Wulff

Osteometer MediTech, Inc.

Hawthorne

CA

USA

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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • S. Prevrhal
    • 1
  • Y. Lu
    • 1
  • H. K. Genant
    • 1
  • J. O. Toschke
    • 1
  • J. A. Shepherd
    • 1
  1. 1.Department of RadiologyUniversity of CaliforniaSan FranciscoUSA

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