Some Physical and Clinical Factors Influencing the Measurement of Precision Error, Least Significant Change, and Bone Mineral Density in Dual-Energy X-Ray Absorptiometry

Dual-energy X-ray absorptiometry (DXA) is the standard method of measuring bone mineral density (BMD) at highly trabecular bone, which can be statistically linked to the risk of fracture. For DXA, precision error (PE) and phantom-based accuracy studies are among the most important routine quality control procedures. A precision study was performed at our institution using International Society for Clinical Densitometry guidelines. Comparing our results with those reported by other investigators, we draw the following general conclusions: the PE was higher for the spine than the hip, which we attribute to the better geometric reproducibility at the hip. The hypothesis that the DXA calculates BMD relative to water was validated. Whether follow-up measurements are performed by the same technologist on the same day-or different technologists on subsequent days-does not appear to have a clinically significant impact on PE or least significant change (LSC). Mixing beam types (i.e., fan and pencil) may affect lumbar PE and LSC measurements more significantly than those of the hip. The use of a single technologist may reduce the PE for the lumbar spine but appears to increase it for the hip. Restricting the patient population to the female gender has the apparent effect of narrowing the gap between lumbar and hip PEs. Finally, the degree of BMD measurement accuracy can be affected by the type of phantom being used (e.g., European Spine Phantom vs Lunar phantom) and the faults in specific DXA edge detection algorithms.