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Precision of GE Lunar iDXA for the Measurement of Total and Regional Body
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Journal of Clinical Densitometry: Assessment of Skeletal Health, vol. 15, no. 4, 399e404, 2012
Ó Copyright 2012 by The International Society for Clinical Densitometry
1094-6950/15:399e404/$36.00
DOI: 10.1016/j.jocd.2012.02.009

Original Article

Precision of GE Lunar iDXA for the Measurement of Total

and Regional Body Composition in Nonobese Adults
Megan P. Rothney,*,1 Francois-Pierre Martin,2 Yi Xia,3 Maurice Beaumont,2
Cynthia Davis,1 David Ergun,3 Laurent Fay,2 Fiona Ginty,1 Sunil Kochhar,2
Wynn Wacker,3 and Serge Rezzi2
1
Computational Biology and Biostatistics Laboratory, GE Global Research Center, Niskayuna, NY, USA; 2Nestec Ltd.,
Nestle Research Center, Lausanne, Switzerland; and 3GE Healthcare, Madison, WI, USA

Abstract
Dual-energy X-ray absorptiometry (DXA) is a well-accepted technique for measuring body composition. Knowl-
edge of measurement precision is critical for monitoring of changes in bone mineral content (BMC), and fat and lean
masses. The purpose of this study was to characterize in vivo precision of total body and regional body composition
parameters using the GE Lunar iDXA (GE Healthcare Lunar, Madison, WI) system in a sample of nonobese sub-
jects. We also evaluated the difference between expert and automatic region-of-interest (ROI) analysis on body com-
position precision. To this end, 2 total body scans were performed on each subject with repositioning between scans.
Total body precision for BMC, fat and lean mass were 0.5%, 1.0%, and 0.5% coefficient of variation (CV), respec-
tively. Regional body composition precision error was less than 2.5% CV for all regions except arms. Precision error
was higher for the arms (CV: BMC 1.5%; fat mass 2.8%; lean mass 1.6%), likely owing to the placement of arms
relative to torso leading to differences in ROI. There was a significant correlation between auto ROI and expert ROI
(r O 0.99). Small, but statistically significant differences were found between auto and manual ROI. Differences
were small in total body, leg, trunk, and android and gynoid regions (0.004e2.8%), but larger in arm region
(3.0e6.3%). Total body and regional precision for iDXA are small and it is suggested that iDXA may be useful
for monitoring changes in body composition during longitudinal trials.

Key Words: Body composition; DXA; precision.

Introduction disease, and monitoring changes in the body as a result of

Body composition measurement with dual-energy X-ray
absorptiometry (DXA) is increasingly used by physicians, di-
eticians, and researchers for a variety of clinical and research
applications (1). Measurement of body composition is widely
used in fields such as nutrition and exercise science, where
changes in lifestyle have a profound impact on the lean and
fat tissue of the human body. It can provide important infor-
mation for capturing disease risks, such as cardiovascular
Received 11/01/11; Revised 02/11/12; Accepted 02/21/12.
*Address correspondence to: Megan Rothney, PhD, GE Global
Research Center, One Research Circle K1-5D27, Niskayuna,
NY 12309. E-mail: rothney@ge.com
aging. The use of DXA in monitoring body composition
has been pointed out by numerous studies on energy balance
and exercise (2), menopause transition (3,4), obesity (5e7),
and various chronic diseases and conditions (1,8e18) in
both adult (19) and pediatric populations (20e23).
DXA measurements have many advantages as compared
with other body composition measurement methods, such as
air displacement plethysmography, computerized tomography
(CT), and magnetic resonance imaging (MRI). Measurements
with DXA take less than 10 min, are noninvasive, have low
interoperator variability, and can provide both total body
and regional (trunk, arms, legs, pelvis, android, and gynoid)
results and automated analysis from a single whole-body
scan. Although the system uses X-ray radiation, the

399
400
measurements are low dose as compared with CT and even
standard X-ray. A whole-body iDXA scan is estimated to
have an effective dose of 0.96 mSv in thin and standard
mode, and 1.92 mSv in thick mode (24), which is considerably
less than the worldwide average background radiation dose of
2400 mSv for a human being per year (25). Therefore, body
composition measurement by DXA is proposed as a reference
standard to which other techniques can be compared.
The GE Lunar iDXA (GE Healthcare Lunar, Madison, WI)
is a fan-beam DXA system released into the market in 2005.
It has demonstrated a high in vivo precision for bone mineral
density (BMD) measurements of the total body, lumbar spine,
femoral neck, and total hip (26). Previous reports on the
iDXA precision have largely been focused on total body pa-
rameters. In these studies, the average precision error (coeffi-
cient of variation) reported was 0.9% for total body fat mass,
0.7% for total body lean mass, and 0.6% for total body bone
mineral content (BMC) (27e31). To date, only 1 publication
has reported precision for regional body composition with
iDXA (26). This study showed precision in the order of CV
lower than 1% in total body and gynoid region, and a CV
of 2.3% for the android region. The purpose of this study
was to establish the measurement precision of the iDXA in
healthy, nonobese men and women for the total body as
well as the trunk, arms, legs, android, and gynoid subregions.
Furthermore, this study sought to characterize the impact of
manual region-of-interest (ROI) selection, which is performed
by some iDXA users, on precision of iDXA measurements.
Methods
Subjects
An independent Ethics Committee located at the Hospital
of Lausanne, Switzerland approved this study. A total of 114
adults (aged: 22.8e60.2 yr, male: n 5 47 and female: n 5 67)
volunteered for the study and were recruited at the Nestle
Research Center. Informed written consent was obtained
from all the subjects. The criteria of exclusion for this study
were pregnancy, obesity (body mass index; BMI O 30kg/m2),
and implanted metal devices.
DXA Measurement
Total body scans were made on a GE Lunar iDXA system
(software version: enCORE version 12.10.113) (GE Health-
care, Madison, WI) with scan mode automatically determined
by the device. For the DXA measurement, all subjects were
wearing a hospital gown and had all metal artifacts removed.
The iDXA unit was evaluated daily using the GE Lunar block
calibration phantom, which ensured that the device was oper-
ating within the manufacturer’s specifications. A single
trained operator performed all scans following the operator’s
manual for patient positioning and data acquisition.
Scans were analyzed with the enCORE software (version
13.60.033) (GE Healthcare, Madison, WI) . The ROIs were au-
tomatically determined by the enCORE software (auto ROI) for
total body, arms, legs, trunk, android, and gynoid regions. An
Journal of Clinical Densitometry: Assessment of Skeletal Health
Rothney et al.
experienced DXA application expert, who did not participate
in data acquisition, also verified and, when indicated, reposi-
tioned the ROI placements (expert ROI) based on the cut line
placement instructions provided in the enCORE operator’s
manual.
Statistical Analysis
Microsoft Excel 2007 and Minitab version 12.23 were
used for the statistical analysis. Descriptive statistics of sub-
jects include group mean, standard deviation (SD), and range.
Precision of DXA at different regions were calculated using
the root mean square SD (RMS-SD) and %CV using the
International Society for Clinical Densitometry guideline
(32). Correlation coefficients, means, and variances for auto
ROI and expert ROI placements were compared using regres-
sion analysis, paired t-tests, and F-tests.
Results
Descriptive statistics of subjects grouped by gender are
listed in Table 1. Participants included 47 male subjects and
67 female subjects. Males and females were of similar age
and BMI. BMI was in the normal to overweight range in
males (21.1e28.2 kg/m2) and females (18.9e29.2 kg/m2)
with only 1 underweight female (BMI 5 18.0 kg/m2).
The mean, range, precision and least significant change
(LSC) for BMC, fat mass, lean mass, region percent fat (region
% fat), and tissue percent fat (tissue % fat) are shown in Table 2
for both total body and subregions (arm, leg, and trunk). Re-
gion % fat is defined as fat mass divided by the sum of fat,
lean, and bone masses, and tissue % fat as fat mass divided
by the sum of fat and lean masses. The %CV ranges from
0.5 to 1.0 for total body, 1.5 to 2.8 for arm, 0.5 to 1.6 for
leg, and 1.0 to 2.0 for trunk. Results of fat mass, lean mass,
and tissue % fat are presented in Table 3 for the android and
gynoid regions. The fat mass precision (RMS-SD) is 31.4 g
for the android region and 45.6 g for the gynoid region.
When comparing auto to expert ROIs, F-tests showed no
statistically significant differences ( p: 0.54e0.99) for vari-
ance between the 2 methods in all regions. Table 4 shows
the comparisons of the mean values calculated using auto
and expert ROI. The mean percentage differences (mean
Table 1
Descriptive Statistics of Subjects
Sex Variables Mean (SD) Range
Males (n 5 47) Age (yr) 39.7 (9.2) 22.8e59.7
Height (cm) 177.0 (6.7) 164.5e193.5
Weight (kg) 76.3 (8.5) 58.4e95.3
BMI (kg/m2) 24.3 (1.9) 21.1e28.2
Females (n 5 67) Age (yr) 38.9 (9.3) 24.6e60.2
Height (cm) 164.2 (6.3) 150.0e184.0
Weight (kg) 59.9 (8.0) 48.0e84.2
BMI (kg/m2) 22.2 (2.5) 18.0e29.2
Abbr: SD, standard deviation; BMI, body mass index.
Volume 15, 2012
iDXA Measurement Precision 401

Table 2
Total Body and Regional Body Precision Acquired by Lunar iDXA

Region Variables Mean (range) RMS-SD CV (%) LSC

Total body BMC (g) 2622 (1595e3766) 12.2 0.5 33.9

Fat mass (kg) 17.3 (7.9e36.7) 0.18 1.0 0.49
Lean mass (kg) 45.92 (32.60e72.70) 0.22 0.5 0.61
Region % fat 27.2 (13.1e45.3) 0.25 d 0.68
Tissue % fat 28.3 (13.7e46.6) 0.26 d 0.72
Arms BMC (g) 364 (226e627) 5.3 1.5 14.7
Fat mass (kg) 2.0 (0.89e4.1) 0.06 2.8 0.16
Lean mass (kg) 5.39 (3.0e10.8) 0.09 1.6 0.25
Region % fat 26.8 (10.6e45.2) 0.52 d 1.44
Tissue % fat 28.1 (11.2e46.7) 0.55 d 1.53
Legs BMC (g) 984 (612e1502) 4.7 0.5 13.1
Fat mass (kg) 6.6 (2.54e14.4) 0.10 1.6 0.28
Lean mass (kg) 15.70 (10.3e24.3) 0.20 1.3 0.56
Region % fat 28.6 (14.3e45.1) 0.29 d 0.81
Tissue % fat 29.8 (15.1e46.7) 0.31 d 0.85
Trunk BMC (g) 739 (409e1132) 11.6 1.6 32.1
Fat mass (kg) 8.64 (2.70e21.74) 0.18 2.0 0.49
Lean mass (kg) 21.69 (13.3e33.9) 0.23 1.0 0.62
Region % fat 27.3 (10.7e51.9) 0.44 d 1.23
Tissue % fat 28.0 (11.0e52.8) 0.46 d 1.28
Abbr: RMS-SD, root mean square standard deviation; CV, coefficient of variation; LSC, least significant change; BMI, body mass index;
BMC, bone mineral content.

difference/mean) for tissue mass ranged from 0.004% to 2.8%
in total body, leg, trunk, android and gynoid regions, and from
3.0% to 6.3% in android and gynoid regions, respectively.
Discussion
In this study, we evaluated the precision of body composi-
tion measurements using Lunar iDXA in 114 nonobese adults.
For the total body, this study demonstrated %CV less than 1%
for BMC, and lean and fat mass, which was similar to that of
previous studies with iDXA (27,28,30,31). Regional precision,
which is not as frequently reported for DXA measurements,
was less than 2.5% in all regions other than the arms, which
had a higher CV for fat mass (2.8%). When compared with
other GE DXA models, iDXA has superior precision for body
composition measurements (28,31). It has also been shown
that the iDXA has improved precision in skeletal measure-
ments, relative to other DXA instruments (26,33,34). Improved
precision may be owing to increased image resolution in the
iDXA image, which allows better tissue point typing.
There is increasing evidence that fat in certain areas of the
body, namely the abdomen, may indicate increased risk of car-
diovascular and metabolic diseases (35e40). For this reason, it
may be important to understand the ability of a DXA instrument
to precisely characterize the tissue composition regionally. In
this study, the precision as measured by %CV, of the android

Table 3
Android and Gynoid Region Precision Acquired by Lunar iDXA

Region Variables Mean (range) RMS-SD CV (%) LSC

Android Fat mass (kg) 1.29 (0.30e4.04) 0.03 2.4 0.09

Lean mass (kg) 3.13 (2.05e4.98) 0.05 1.7 0.15
Tissue % fat 27.9 (8.1e56.7) 0.60 d 1.67
Gynoid Fat mass (kg) 3.33 (1.45e7.49) 0.05 1.4 0.13
Lean mass (kg) 7.14 (4.79e11.13) 0.08 1.1 0.21
Tissue % fat 31.9 (16.1e51.4) 0.43 d 1.19
A/G % fat ratio 0.90 (0.36e1.61) 0.024 d 0.065
Abbr: RMS-SD, root mean square standard deviation; CV, coefficient of variation; LSC, least significant change; A/G, android to gynoid ratio.

Journal of Clinical Densitometry: Assessment of Skeletal Health Volume 15, 2012

402 Rothney et al.

Table 4
Comparison Between Auto ROI and Expert ROI Placement

Region Variables Mean difference 95% CI for Mean difference % Difference

Total Body BMC (g) 1.2 14.4, 16.9 0.05

Fat mass (g) 5 356.0, 366.0 0.03
Lean mass (g) 2 298, 302 0.004
Region % fat 0.01 0.5, 0.5 d
Tissue % fat 0.01 0.5, 0.5 d
Arm BMC (g) 10.9 8.1, 13.7 3.0
Fat mass (g) 122.4 83.3, 161.5 6.3
Lean mass (g) 174.8 127.6, 221.9 3.3
Region % fat 0.6 0.1, 1.1 d
Tissue % fat 0.6 0.1, 1.2 d
Leg BMC (g) 1.8 5.8, 9.3 0.2
Fat mass (g) 10.9 105.4, 127.3 0.2
Lean mass (g) 65.8 43.7, 175.3 0.4
Region % fat 0.06 0.39, 0.50 d
Tissue % fat 0.06 0.39, 0.50 d
Trunk BMC (g) 15.6 9.0, 22.3 2.1
Fat mass (g) 156 71, 384 1.8
Lean mass (g) 352.2 165.5, 538.8 1.6
Region % fat 0.07 0.6, 0.7 d
Tissue % fat 0.07 0.6, 0.7 d
Android Fat mass (g) 22.3 16.8, 61.4 1.7
Lean mass (g) 89.0 55.1, 122.9 2.8
Tissue % fat 0.2 0.6, 1.0 d
Gynoid Fat mass (g) 48.6 23.5, 120.7 1.4
Lean mass (g) 146.7 85.8, 207.6 2.0
Tissue % fat 0.1 0.4, 0.7 d
A/G % fat ratio 0.1 1.2, 1.5 d
Abbr: ROI, region of interest; CI, confidence interval; BMC, bone mineral content; A/G, android to gynoid ratio.

and gynoid regions, which encapsulate waist and hip fat depots,
was approximately 2%. This suggests that the changes that
might be encountered in a weight loss program targeted toward
prevention of cardiometabolic disease (5e10%) could be de-
tected with the device and should not be confounded by noise
from the DXA data acquisition (41e45).
The largest variation seen in this study is in the arm region,
with RMS%CV 2.8% for fat mass and 1.6% for lean mass.
This may be owing to the orientation of the palms relative
to the DXA table, which was not perfectly standardized in
our cohort, or may be owing to the position of soft tissue of
the trunk extending toward the arms making it difficult to as-
sign tissue consistently to the arm ROI in each scan. Also, be-
cause arms are small region of the body, modest changes in
the total fat and lean mass can lead to larger percentage
changes than are observed in the trunk. This finding is consis-
tent with reports on arm precision from previous DXA im-
ages, which showed a range of precision values from 3.5%
to 11.4% (46e48).
We found high correlation between auto ROI and expert ROI
method (r O 0.99) in our study. However, statistically signifi-
cant differences between means are demonstrated in many
regions of the body. The differences, as characterized by per-
centage differences, are relatively small in regions such as
leg, trunk, android, and gynoid regions (0.004e2.8%) when
compared with arm region, where the average difference in
fat mass is 6.3%. Because the arm ROI seems to have the largest
percent difference between manual and automatic region detec-
tion, it is critical that investigators perform manual checks of
their images and adopt a standard procedure for modifying
ROIs within a given study.
One important value of DXA measurements is the ability
to make measurements longitudinally allowing for monitoring
of an intervention targeted either toward weight loss, change
in tissue from fat to lean mass or in BMD. Therefore, the pre-
cision of the measurement is an important factor in determin-
ing the utility of an instrument in this context. Previous
reports of regional body composition have generally shown
precision values, outside the arms, of between 2% and 5%
(46e48). Results shown here and in other reports on the
iDXA (26) show smaller values, in the order of 1% for total
body and 1e3% for the regional measurements. Taken
together, these observations suggest that the precision in the
iDXA system is improved over previous GE DXA scanners

Journal of Clinical Densitometry: Assessment of Skeletal Health Volume 15, 2012

iDXA Measurement Precision
(30,49), which may make it very suitable as a monitoring tool
in nutritional studies.
There are several limitations in our study. First, obese sub-
jects were not included. It is possible that precision error will
be higher in these subjects, and these differences should be
characterized. This age range of our study participants is
also relatively young. Because metabolic and cardiovascular
disease incidence increases with age, it is important to con-
sider whether age is an important recruiting criterion. In our
present study, age is not considered to be a factor likely to im-
pact iDXA body composition precision. This should be veri-
fied in a study of older adults. Finally, this study does not
consider precision over longer periods of time, which would
better represent the time intervals in longitudinal trials.
Long-term precision is important to understand but very dif-
ficult to measure in body composition studies as subjects with
a similar body weight at 2 time points may have different
body composition. Long-term precision studies in phantoms
or well-controlled clinical populations could add to our un-
derstanding of the precision of iDXA body composition mea-
surements.
Conclusions
Regional precision in iDXA makes it an attractive choice for
investigators monitoring longitudinal changes in body compo-
sition for the purposes of weight loss, weight gain prevention,
and growth and development as small changes in regional com-
position can be detected. Over the past decades, changes in diets
and lifestyles have evolved rapidly having a direct influence on
the body composition and health status of populations, with in-
ferred effects on the development of chronic diseases [e.g., di-
abetes and cardiovascular diseases (50,51)]. The use of precise
and region-specific body composition parameters offers
a promising opportunity to understand better how nutrition
and lifestyle impact body composition and metabolic health
of individuals and populations. Eventually, such an approach
may help assessing the region-specific bioefficacy of selected
foods and may provide novel avenues for the determination
of active ingredients for personalized nutritional solutions.
Acknowledgments
We would like to acknowledge the Nestle research center
metabolic unit staff, Mrs Sylviane Oguey Araymon, Anny
Blondel Lubrano and Corine Nielsen Moennoz, for their tech-
nical support.
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Volume 15, 2012