The European Spine Phantom — a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT
Abstract
The lack of standardization in bone mineral measurements of the lumbar spine and other skeletal sites is generally recognized as an important and unresolved issue. We report and discuss efforts at standardization and cross-calibration of DXA and QCT equipment. We have designed and tested a geometrically defined, semi-anthropomorphic phantom, the European Spine Phantom (ESP). It contains a spine insert consisting of three vertebrae of increasing bone mineral densities and thicknesses of cortical structures; the respective parameters are given in tabular form for the final phantom design. Results for cross-calibration with the ESP compare well with patient results. Measurements on the first 30 phantoms confirmed that the ESP can be manufactured with a variation of about 1%. We conclude that the ESP is suitable for daily quality assurance, cross-calibration of instruments and universal standardization. The ESP was used to establish standardized BMD (sBMD) units for DXA equipment going into effect in late 1995. Its acceptance by manufacturers as a calibration standard for DXA and QCT measurements appears imminent.
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A previous experimental study with spectral localizer radiographs from PCD-CT using the European Spine Phantom showed that spectral localizer radiographs were more accurate than DXA at higher bone density.
“A previous experimental study with spectral localizer radiographs from PCD-CT using the established European Spine Phantom21 showed that spectral localizer radiographs were more accurate that DXA at higher bone density.13”
From In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT (2025) · cites this paper as [21]
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Self-citationLi, X., Li, X., Li, J., Jiao, X., Jia, X., Zhang, X., Fan, G., Yang, J., & Guo, J. (2020) · Clinical Radiology · doi:10.1016/j.crad.2019.11.008 · Cited by 41 · see citing works
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Moser, L. J., Klambauer, K., Diaz Machicado, M. C., Frey, D., Mergen, V., Eberhard, M., Nowak, T., Schmidt, B., Flohr, T., Distler, O., et al. (2025) · Investigative Radiology · doi:10.1097/rli.0000000000001159 · Cited by 8 · see citing works
- Authors
- Kalender, W. A., Felsenberg, D., Genant, H. K., Fischer, M., Dequeker, J., & Reeve, J.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- University of California, San Francisco (US)
- KU Leuven (BE)
- University of Cambridge (GB)
- Corresponding author
- Kalender, Willi A.
- Venue
- European Journal of Radiology
- Publisher
- Elsevier BV
- Published
- 1995-07
- Volume
- 20
- Issue
- 2
- Pages
- 83-92
- ISSN
- 0720-048X (ISSN-L)
- OpenAlex
- W2023173649
- Cited by
- 263
- References
- 0
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 4 · 2021: 11 · 2020: 4 · 2019: 5 · 2018: 7 · 2017: 14 · 2016: 5 · 2015: 6 · 2014: 15 · 2013: 9 · 2012: 8
- FWCI
- 10.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Physical Sciences › Engineering › Biomedical Engineering › Medical Imaging and Analysis
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- lumbar spine bone mineral density, dual-energy X-ray absorptiometry, quantitative computed tomography, quality assurance, cross-calibration, bone densitometry
- MeSH terms
- Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Models, Anatomic, Osteoporosis, Quality Control, Reference Standards, Spine, Tomography, X-Ray Computed, Absorptiometry, Photon, Bone Density
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