A technical and clinical evaluation of digital X-ray radiogrammetry

Area of Science:

• Radiology and Imaging
• Bone Densitometry
• Osteoporosis Diagnosis

Background:

• Traditional radiogrammetry for skeletal assessment has limitations in precision and technical aspects.
• Digital X-ray radiogrammetry (DXR) enhances radiogrammetry with sophisticated methodology to overcome these issues.

Purpose of the Study:

• To evaluate the impact of radiographic technique on DXR bone mineral density (BMD) measurements.
• To compare DXR with dual-energy X-ray absorptiometry (DXA) and single-energy X-ray absorptiometry (SXA).
• To determine DXR's utility in identifying patients suitable for axial DXA referral.

Main Methods:

• Investigated the influence of different radiographers and film types (single-sided vs. double-sided emulsion) on DXR precision and BMD measurements.
• Compared DXR-derived BMD with DXA and SXA measurements.
• Assessed DXR's sensitivity and specificity in detecting osteopenia and osteoporosis using DXA T-scores.

Main Results:

• Radiographic technique and radiographer variations did not adversely affect DXR precision.
• Single-sided film yielded better precision than double-sided film.
• DXR showed moderate to excellent correlations with DXA and SXA (r=0.56-0.91).
• DXR demonstrated high sensitivity and specificity (AUC=0.82-0.84) for identifying osteoporosis.
• A DXR T-score threshold of -1.05 on the femoral neck is proposed for identifying patients needing axial DXA.

Conclusions:

• DXR is a precise, simple, and potentially cost-effective method for BMD assessment.
• DXR can be effectively used in various settings, including retrospective analysis.
• DXR aids in identifying patients at risk of osteoporosis who would benefit from axial DXA, particularly those with low-trauma fractures.