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A single site, multi-operator precision study for second-generation HR-pQCT.

Joshua R Stapleton¹, Nina Z Heilmann², Kristin Cattell¹

¹Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States.

|June 23, 2026

Summary

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This summary is machine-generated.

High-resolution peripheral quantitative computed tomography (HR-pQCT) offers precise bone measurements. Standardized technologist training ensures consistent scan-rescan precision across operators, crucial for longitudinal bone studies.

Area of Science:

Orthopedics and Bone Imaging
Medical Physics
Radiological Sciences

Background:

High-resolution peripheral quantitative computed tomography (HR-pQCT) is increasingly used for bone dynamics research.
Existing HR-pQCT precision data often rely on older technology and limited operator/population diversity.
Ensuring reproducibility is vital for longitudinal HR-pQCT studies.

Purpose of the Study:

To investigate the influence of operator characteristics and participant demographics on HR-pQCT measurement precision.
To establish reference values for scan-rescan precision in a standardized academic imaging center.
To assess the impact of technologist variability on HR-pQCT outcomes.

Main Methods:

45 adult participants underwent same-day repeat HR-pQCT scans of the distal tibia and radius.

Keywords:

BMD HR-pQCT bone bone microarchitecture precision error statistical methods

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Three imaging technologists acquired 15 scan pairs each, with standardized post-processing.

Statistical modeling analyzed the effects of technologists and participant demographics (age, sex, BMI).

Main Results:

Root-mean-square coefficients of variation were ≤1.3% for bone mineral density and <2% for area measures.
Trabecular microarchitecture precision ranged from 1.14% to 2.82%.
Cortical thickness precision was ≤1.99%, while cortical porosity precision was higher (20.90-24.66%).
No significant differences in precision were found based on technologist or participant demographics.
Image quality scores did not impact precision outcomes.

Conclusions:

Standardized technologist training yields consistent HR-pQCT scan-rescan precision across operators.
These findings provide reference values for least significant change in HR-pQCT parameters.
The study supports the reliability of HR-pQCT for longitudinal bone research with standardized protocols.