The European Spine Phantom — a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT

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.