Workflow for Quality DXA-based bone density testing

Typical medical imaging workflow, as discussed in our prior post, works well in most radiology practices.  However, bone density testing via DXA is a unique form of medical imaging.  Some ways in which DXA is unique:

  • DXA produces quantitative data in addition to images
  • Accurate patient demographic information is required for an interpretation along with a FRAX score
  • Reading physicians are required to confirm proper and consistent positioning

In this posting, we’ll examine how BoneStation, a web-based bone density reporting system, provides an efficient workflow while simultaneously addressing many of the unique characteristics of DXA.   Many of the features and capabilities described below are based on experiences at high volume bone density practices over the past twelve years and with more than a half million bone density reports created at these practices using BoneStation.

DXA produces numbers, in addition to images.  PACS are not designed to deal with numbers, and dictation is tedious and error prone. BoneStation extracts all BMD data and makes them available during review.  This is described in our post, There is NO need to re-enter your DXA data when reporting.

Bone density also requires accurate patient demographic information for an assessment. If a FRAX score is being calculated, then risk factors are also required.  BoneStation verifies that information is not missing.  It can notify the technologist before an attempt is made at reading the scans.  Some examples of info may be omitted:

  • Height is often used at determining height loss.
  • Height and weight are needed for FRAX, which uses BMI as in input.
  • Ethnicity is important for interpretation.

BoneStation includes FRAX and includes an online questionnaire, which may be customized.  The questionnaire in the DXA software is not used.  There are many advantages to having the FRAX questionnaire online, as described here.  Some examples:

  • The reading physician may make changes to responses to FRAX questions during review.  There is no need to have the technologist change the answer on the DXA to have the FRAX score recalculated there.
  • BoneStation can confirm that a questionnaire has been filled in and notify staff when it is missing – before the scans are read.
  • BoneStation warns staff of inconsistencies in scan and FRAX info.  For example, a 65 year old patient may be designated as pre-menopausal.  This can be significant when menopausal status is used in determining the assessment or reporting of FRAX.

An online questionnaire may be very helpful in research settings too.  All scan and patient history information is easily accessible in real-time, which may be useful for data mining.

Here are some sample questionnaires.

So far we’ve discussed issues that occur early in the process, before scans are read.  BoneStation provides numerous workflow and quality benefits during the reading process too:

  • Images and BMD data for prior scans are available quickly and easily during review.
  • Generation of the assessment and FRAX is automatic.  This is possible because BoneStation makes decisions based on the extracted BMD data.
  • BoneStation incorporates re-analysis of scans into its workflow.  No more post-it notes or lost scan results because reanalysis of a scan was forgotten about. BoneStation tracks scans being reanalyzed.

This video demonstrates reading of a bone density study in under ninety seconds.

Here is a longer video that describes bone density reporting with BoneStation in high volume practices.

BoneStation builds upon radiology workflows while also supporting DXA specific requirements.  Both a high volume of testing may be maintained as well as quality.

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