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Standardizing Evaluation of pQCT Image Quality in the Presence of Subject Movement: Qualitative Versus Quantitative Assessment

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Abstract

Peripheral quantitative computed tomography (pQCT) is an essential tool for assessing bone parameters of the limbs, but subject movement and its impact on image quality remains a challenge to manage. The current approach to determine image viability is by visual inspection, but pQCT lacks a quantitative evaluation. Therefore, the aims of this study were to (1) examine the reliability of a qualitative visual inspection scale and (2) establish a quantitative motion assessment methodology. Scans were performed on 506 healthy girls (9–13 years) at diaphyseal regions of the femur and tibia. Scans were rated for movement independently by three technicians using a linear, nominal scale. Quantitatively, a ratio of movement to limb size (%Move) provided a measure of movement artifact. A repeat-scan subsample (n = 46) was examined to determine %Move’s impact on bone parameters. Agreement between measurers was strong (intraclass correlation coefficient = 0.732 for tibia, 0.812 for femur), but greater variability was observed in scans rated 3 or 4, the delineation between repeat and no repeat. The quantitative approach found ≥95 % of subjects had %Move <25 %. Comparison of initial and repeat scans by groups above and below 25 % initial movement showed significant differences in the >25 % grouping. A pQCT visual inspection scale can be a reliable metric of image quality, but technicians may periodically mischaracterize subject motion. The presented quantitative methodology yields more consistent movement assessment and could unify procedure across laboratories. Data suggest a delineation of 25 % movement for determining whether a diaphyseal scan is viable or requires repeat.

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Acknowledgments

We appreciate the participation and support of principals, teachers, parents, and students from the schools in the Catalina Foothills and Marana School Districts. We also thank the radiation technicians and all other members of the Jump-In study team for their contributions. The project was supported by award HD-050775 (S. B. G.) from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Physiological Sciences, The University of Arizona, 1713 E. University Blvd. #93, Tucson, AZ, 85721-0093, USA

    Robert M. Blew & Vinson R. Lee

  2. Endocrine Research Unit, Guggenheim 7-95, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Joshua N. Farr

  3. Bone Diagnostic Inc., 1114 Elsie St., Fort Atkinson, WI, 53538, USA

    Daniel J. Schiferl

  4. Department of Nutritional Sciences, The University of Arizona, Shantz Building #309, 1177 E. 4th St., Tucson, AZ, 85721, USA

    Scott B. Going

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  1. Robert M. Blew
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  2. Vinson R. Lee
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Correspondence to Robert M. Blew.

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The authors have stated that they have no conflict of interest.

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Blew, R.M., Lee, V.R., Farr, J.N. et al. Standardizing Evaluation of pQCT Image Quality in the Presence of Subject Movement: Qualitative Versus Quantitative Assessment. Calcif Tissue Int 94, 202–211 (2014). https://doi.org/10.1007/s00223-013-9803-x

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  • DOI: https://doi.org/10.1007/s00223-013-9803-x

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