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.

Structured BMD Data Permits Easy Query and Data Analysis

The two prior posts, Bone Density Reporting and PACS and The Evolution of Bone Density Reporting, prompted feedback from readers and BoneStation users.  The articles mentioned that quantitative bone mineral density data (BMD, t-score, z-score, etc.) is available in a structured form in the DICOM format.  Apparently this is quite appealing to physicians and researchers who would like to analyze and mine bone density data.

In this posting we will provide more information the bone density data in DICOM files.  We will describe where the data is stored, how it may be accessed, and the types of things that can be done with it.

Bone density data is available in the DICOM transmissions of bone density scans.  Specifically, BMD data is available in two forms – a raw image and a structured form.  The raw image is of little use in terms of analysis because the numerical information (area, BMC, BMD, t-score, and z-score) can not be extracted out of the image.  However, the structured form may be of considerable value because it can be parsed.

The structured BMD data is not visible when looking at a DICOM image.  The data is stored in private DICOM elements.  GE/Lunar and Hologic use their own proprietary formats.  Fortunately, each DXA manufacturer documents their format.  We have seen very few systems that utilize the structured BMD data stored in DICOM and have yet to encounter a PACS that makes use of the private data.

The DICOM standard supports many modalities – CT, Ultrasound, etc.  Unfortunately, DXA is not one of them.  This is the reason the DXA manufacturers have created their own private DICOM fields for storing BMD data.

BoneStation depends heavily on the structured BMD data.  It parses the data and stores it in its database.  From there, BoneStation can display the data in ways that are useful to physicians.  It can:

  • Perform calculations, such as change in BMD between arbitrary scans
  • Highlight scans performed on different DXA machines or with different scan modes
  • Highlight questionable scan values
  • Assist the physician in assessing an exam – for example, an interpretation may be provided based on t-score

Of course, more than just scan data is available.  BoneStation captures additional information, some of which is customized per user.  Some of this information is entered during the review process and some via an online patient history questionnaire.  A sample of data that may be available:

  • Treatments, current and past
  • FRAX risk factors
  • ICD9 codes
  • Vertebral Fracture Assessment (VFA) fractures, including severity and type
  • Etc…

All of this information is stored in a standard relational database and may be queried using Structured Query Language (SQL).  Tools such as Microsoft Excel and Crystal Reports may be used to access the database. A wide variety of queries may be performed.  Here is a very small sample of the types of queries that may be of interest.

  • How many bone density scans were performed by month for the past year.
  • Find all patients with a t-score within a range – say t-score <= -2.5.
  • Find all male patients under 65 with a t-score below -2.5.
  • Find all patients being treated for osteoporosis who are osteopenic.
  • How many patients are being treated with a specific ICD9 code for each of the past 3 years.
  • Find patients with a moderate or worse VFA fracture.
  • How many scans is each physician reviewing.
  • How many scans have poor quality.
  • How much time does each physician take to interpret scans.

Some astute readers picked up on the value of structured BMD data in DXA DICOM transmissions.  Structured data can be stored in an organized fashion and easily queried and mined for clinical, quality, research, and financial purposes.

BoneStation: The Software Tool for Bone Densitometry

BoneStation automates the preparation, interpretation, creation, distribution and storage of bone density reports using DXA technology. A web-based interface streamlines the review process for bone density practitioners into a single, secure, interconnected system that processes reports in 1/3 of the time. BoneStation enables practices to provide more accurate bone health assessments and increase revenue without adding administrative staff, transcription services or additional practitioners – directly improving quality of care and profit margins.