The preparation of strontium-substituted hydroxyapatite bone phantoms with high strontium concentrations

Long-term stability of hydroxyapatite bone phantoms for the calibration ofin vivox-ray fluorescence spectrometry-based systems of bone lead and strontium quantification

Hydroxyapatite (HAp) phantoms have been proposed as an alternative to plaster of Paris (poP) phantoms for the calibration of x-ray fluorescence-based systems for thein vivoquantification of bone lead and strontium which employ a coherent normalization procedure. The chemical composition of the material becomes critical in the calculation, or omission, of the coherent correction factor (CCF) required in this normalization procedure. This study evaluated the long-term chemical stability of HAp phantoms. Phantoms were prepared and allowed to age for a two week period and over a seven year period in ambient conditions. The chemical composition of the phantoms was then assessed by powder x-ray diffraction. Two week old phantoms were found to be composed of HAp with only a small amount of contamination from CaHPO4·2H2O. Seven year old phantoms were found to have converted nearly completely to a carbonate-bearing apatite in the form of Ca10(PO4)6(CO3)0.75(OH)0.5indicating that the HAp phantom material likely reacts with carbon dioxide in air over time forming a carbonate-bearing apatite. The influence of this chemical conversion was assessed at the level of relevant cross-sections. Calibration under the assumption that the material is HAp when in fact it is a carbonate-bearing apatite would result in not more than a 0.2%-2% bias in the total mass attenuation coefficient within the photon energy range of 0-100 keV. Differential scattering cross-section for coherent scattering was found to differ between HAp and carbonate-bearing apatite by 0.9%-2% for both a 35.5 keV and 88.0 keVγ-ray. This variation in the differential scattering cross-section for coherent scattering may introduce a ca. 2% bias in the CCF used within the coherent normalization-based calibration procedure. Using HAp phantoms as calibrators thus requires acknowledgement of this conversion in chemical form and possible introduction of uncertainty into the calibration procedure.

Assessment of the effect of strontium, lead, and aluminum in bone on dual-energy x-ray absorptiometry and quantitative ultrasound measurements: A phantom study

PURPOSE

Dual-energy X-ray absorptiometry (DXA) is the gold standard technique to measure areal bone mineral density (aBMD) for the diagnosis of osteoporosis. Because DXA relies on the attenuation of photon to estimate aBMD, deposition of bone-seeking metallic elements such as strontium, lead, and aluminum that differ in atomic numbers from calcium can cause inaccurate estimation of aBMD. Quantitative ultrasound (QUS) is another technique available to assess bone health by measuring broadband ultrasound attenuation (BUA), speed of sound (SOS), and an empirically derived quantity called stiffness index (SI). Because the acoustic properties are not prone to significant change due to changes in microscopic atomic composition of bone, it is hypothesized that QUS is unaffected by the presence of bone-seeking elements in the bone. The objective of this study was to investigate the effect of strontium, lead, and aluminum on DXA-derived aBMD and QUS parameters using bone-mimicking phantoms compatible with both techniques.

METHODS

Bone-mimicking phantoms were produced by homogeneously mixing finely powdered hydroxyapatite compounds that contain varying concentrations of strontium, lead, or aluminum with porcine gelatin solution. Seven strontium-substituted phantoms were produced with varying molar ratio of Sr/(Sr + Ca) ranging from 0% to 2%. Four lead-doped phantoms and four aluminum-doped phantoms were constructed with the respective analyte concentrations ranging from 50 to 200 ppm. An additional 0 ppm phantom was produced to be used as a baseline for the lead and aluminum phantom measurements. All phantoms had uniform volumetric bone mineral density (vBMD) of 200 mg/cm³ , and were assessed using a Hologic Horizon^® DXA device and a Hologic Sahara^® QUS device. Furthermore, theoretical aBMD bias for mol/mol% substitution of calcium with the three bone-seeking elements was calculated.

RESULTS

Strong positive linear relationship was found between aBMD measured by DXA and strontium concentration (P < 0.001, r = 0.995). From the measurement of lead and aluminum phantoms using DXA, no statistically significant relationship was observed between aBMD and the analyte concentrations. For the QUS system, with an exception of BUA and lead concentration that exhibited statistically significant relationship (P < 0.038, r = 0.899), no statistically significant change was observed in all QUS parameters with respect to the clinically relevant concentration of all three elements. The calculated theoretical aBMD bias induced by 1 mol/mol% substitution of calcium with strontium, lead, and aluminum were 10.8%, 4.6%, and -0.7%, respectively.

CONCLUSION

aBMD measured by DXA was prone to overestimation in the presence of strontium, but acoustic parameters measured by QUS are independent of strontium concentration. The deviation in aBMD induced by the clinically relevant concentrations of lead and aluminum under 200 ppm could not be detected using the Hologic Horizon^® DXA device. Furthermore, the SI measured by the QUS system was not affected by lead or aluminum concentrations used in this study.