Three Keys to Quality Bone Density Reporting

This posting is the last of a 3-part series about bone density reporting and how BoneStation can make a difference compared to common practices. Part 1 focused on costs reduction and part 2 on time savings.  In this article we discuss three specific areas that BoneStation addresses in regards to quality:

  • The Report – components that comprise a good bone density report
  • Review process – facilitating a sound interpretation
  • Workflow – improving communications between staff

The Report
The International Society for Clinical Densitometry defines the minimum requirements for a bone density report.  Some items that should appear on a report include: patient demographics, BMD values for each site measured, DXA manufacturer/model, and significant change.

BoneStation automates report creation.  Manual data entry is eliminated.  BoneStation extracts all appropriate DXA data and places the data in a report.  In addition, changes in BMD and determination of significant change are automated.  A final bone density assessment is even suggested.

The Review Process
While DXA bone density scan images should not be used for diagnostic purposes, they are instrumental in determining the consistency of serial measurements.  Is the patient positioned properly?  Are the regions of interest (ROIs) consistent with prior scans?  What is the technical quality of the scans?

BoneStation’s review process is designed to highlight key aspects for interpretation.  Prior scans are easily visible. ROIs may be viewed both visually and numerically.  Technical quality of scans must be specified and may also appear on the report.


In most situations, the technologist and reading physicians are in different locations.  Scans are not typically read in real time either.  Improved communications among bone density staff can lead to increased quality.

  • BoneStation allows technologists to pass information to reading physicians via “scan comments”, which are entered on the DXA and appear in BoneStation.
  • BoneStation may be configured to “validate” patient information for consistency.  Is data missing, is patient demographic info consistent, etc.  For example, if a female patient is 62 years old and is designated as pre-menopausal, BoneStation is able to provide a warning that this information may not be valid.
  • When a reanalysis is required, BoneStation facilitates communications between the reading physician and technologist.  The reason for reanalysis is described to the technologist.  The scan is also tracked as awaiting reanalysis – so staff will not lose track of it.

BoneStation is designed specifically for DXA based bone densitometry.  It increases efficiency and quality simultaneously.  Much of the mundane handling of bone density scans is automated. It facilitates a review process designed for bone density, and enables easy communication among bone density staff.

BoneStation has produced more than a half million reports and has proven to be reliable solution for BMD reporting.  Customers such as Mass General Hospital, Swedish Medical Group, Emory and others enjoy higher throughput and quality at lower cost.

Bone Density Reporting and PACS

In our last post, The Evolution of Bone Density Reporting, we looked at how reporting for DXA progressed from manual reporting to cloud based solutions.  We skipped a method of reporting that utilizes Picture Archiving and Computer Systems (PACS).  Many radiologists use PACS for a variety of modalities, including DXA.  We’ll examine bone density reporting with PACS and make comparisons with DXA specific reporting solutions that were discussed in the prior post.

PACS is a key tool used by modern radiology departments.  A typical system consists of a large amount of digital storage, high fidelity DICOM display terminals, and software.  A variety of modalities (digital x-ray, CT, MRI, DXA, etc…) transmit scans to PACS utilizing DICOM.  The images are stored in PACS and can be viewed via DICOM displays.  The amount of storage determines how long images can be recalled and viewed.  After a period of time, images are typically archived and may not be immediately available.

Bone density reporting is often performed with PACS and dictation software.  Typically a radiologist will view a bone density scan on a DICOM display while also dictating or transcribing a report.  This process is consistent with how radiologists create reports for other modalities.

One disadvantage to dictation/transcription is quality.  In our last post we noted quality was addressed with the DXA manufacturer provided reporting software as well as BoneStation.  Bone density scans contain images plus quantitative data, such as BMD, t-score, and z-score.  DXA specific software extracts the data and places it in a report.  With dictation, the radiologist must speak these values in order to transfer them into the report.  This method of transferring numeric data into a report is reminiscent of manual reporting – errors may occur.

It is important to note that the bone density quantitative data is available in two ways within the DICOM transmission.  First, the data is burned into the bone density scan image.  When a radiologist views a bone density image in PACS, it is these values that are transcribed.  There is very little else that can be done with data burned into an image.  Second, and more importantly, bone density data (BMD, t-score, z-score, etc) is also available as values in private DICOM elements.  These values may be extracted, parsed, and placed in a report. Software may read these values and perhaps even aid in decision making.  Calculations, such as change in BMD may be performed in software.  A FRAX risk factor may also be calculated.

We have seen few systems that utilize the values in the private DICOM elements.  PACS is largely used for storing and displaying of images and while it works well with many modalities, it typically ignores BMD data in DXA scans.  The process of dictation/transcription represents a somewhat manual method of transferring the values from the scan into a report.

Another important capability of reading DXA scans is to follow a patient’s progress.  A reader of bone density scans typically compares a current scan with historical scans – by viewing scans side-by-side. Regions of interest (ROIs) are compared for consistency over time.  PACS usually retains images for a certain amount of time.  Historical scans may not readily be available, however.

In summary, PACS is a great tool for modalities that produce images only.  For DXA scans, however, there is a gap in handling of quantitative data that is available in the bone density scans.  In actuality, it lacks the capabilities of even the first generation of bone density software reporting tools.