A study of the long-term precision of dual-energy X-ray absorptiometry bone densitometers and implications for the validity of the least-significant-change calculation

Abstract

Introduction: Short-term precision is often quoted and used as the most important performance parameter of a dual-energy X-ray absorptiometry (DXA) scanner; however, long-term precision has a more profound impact on patient monitoring. Long-term precision refers to the combination of in-vivo precision errors and long-term equipment stability.

Methods: To monitor long-term equipment stability, a phantom was designed with four inserts ranging in bone-mineral density from 0.5 to 3.3 g/cm(2). This phantom was used to monitor the equipment stability of four modern fan-beam densitometers, two each from Hologic and GE/Lunar, over a 4-year period. Manufacturer-recommended quality assurance (QA) procedures were performed, and the scanners stayed within manufacturer-specified tolerances throughout the study.

Results and conclusion: During the 4-year period, the Hologic scanners were observed to cause clinically insignificant BMD shifts (maximum of 0.34%), whereas the GE/Lunar scanners revealed BMD shifts that were clinically significant (1.5% and 2.1%). As a result, using least-significant-change (LSC) calculations based only on short-term in-vivo precision studies for monitoring patients is not valid for the two GE/Lunar densitometers due to the poorer long-term stability they exhibited.