Dual-energy digital radiography for the assessment of bone mineral density

BACKGROUND: Bone mineral density (BMD) is usually determined by dual-energy X-ray absorptiometry (DXA). Digital radiography (DR) has enabled the application of dual-energy techniques for separating bone and soft tissue, but it is not clear yet whether BMD information can reliably be obtained using DR. PURPOSE: To determine the ability of dual-energy digital radiography (DEDR) to predict BMD as determined by DXA. MATERIAL AND METHODS: Reindeer femora (n=15) were imaged in a water bath at a typical clinical imaging voltage of 79 kVp and additionally at 100 kVp on a DR system. BMD was determined in four segmented regions (femoral neck, trochanter, inter-trochanter, Ward's triangle) from these images using the DXA calculation principle. BMD results as determined by DEDR were compared with BMD values as determined by DXA. RESULTS: Significant moderate to high linear correlations (0.66-0.76) were observed at the femoral neck, Ward's triangle, and trochanter between BMD values as determined by the two techniques. The coefficient of variation (CV(RMS)) ranged between 2.2 and 4.7% and 0.2 and 1.8% for DEDR and DXA analyses, respectively. CONCLUSION: DXA-based BMD information can be obtained with moderate precision and accuracy using DEDR. In future, combining BMD measurements using DEDR with structural and geometrical information available on digital radiographs could enable a more comprehensive assessment of bone.