BoneStation is a web-based reporting solution which increases the productivity of bone density testing providers, including technologists, physicians, and administrators. In this article we focus on physicians who are responsible for the review and interpretation of BMD and VFA scans. The physician will essentially do the following: select the exam to review, assess the technical quality of each scan, and generate the report by filling in the various components (Assessment, Recommendations, Fracture Risk, etc). We describe that process in further details below.
The Review List and Initiating the Review Process
The physician starts by looking at The Review List, a list of recently performed BMD scans which need to be read.
- Review List shows scans awaiting review. (click for full size)
In this case the system shows 29 exams ready to be reviewed. Notice the drop down menus at the top. These are particularly useful in situations where there are multiple DXA machines and multiple reviewers. The Exam Date filters the list to show scans performed on a particular day. The Location filters the list based on the DXA machine’s geographic location. The list can also be sorted by Patient, Exam Date, and Referring Physician. In this Review Step 1, the physician initiates the review process by clicking on Create Report (left button).
Selecting the relevant historical scans
Review Step 2 appears as “Select Comparison Scans”. During this step the current PA spine scan and all historical PA spine scans are displayed in summary fashion. Prior scans that the physician does not want included can be excluded from the report by clicking the Exclude checkbox.
- On Review Step 2 prior scans may be excluded. (click for full size)
The screen shows a summary of each prior scan, including scan date, scan mode, serial number of DXA machine, analysis date, and relevant BMD data. If a prior scan was performed on a different DXA or using a different scan mode, the corresponding data would be highlighted in red. This alerts the reviewer to the fact that he may want to exclude the scan. For example:
Scan mode differs and is highlighted.
Looking back at Review Step 2, notice that “OK” appears in the Tech Quality column for the 11/10/2011 scan. The 2011 scan has a report that was created in BoneStation and its technical quality was evaluated to be OK at the time of review. Clicking OK pops up that report for immediate viewing.
Assessing Scan Quality
Click the Continue button to move to the next step. On Review Step 3 one can compare the images of the current scan and the baseline. Additional images, with scan data, may be viewed by clicking the dates in the Other Historical Scans section.
Review Step 3
On Review Step 3 the reviewer indicates the technical quality of the scan as either OK, marginal, or uninterpretable. When one of the latter two is selected, one or more reasons must be picked in the second column. If a scan is designated as uninterpretable, it will not be used in the final assessment. It is also during this step that a reviewer may request for a scan to be reanalyzed. In this case the physician reviewer is prompted to send instructions to the technologist via email. The scans are retained in BoneStation in a separate “Awaiting Reanalysis” queue.
Summarizing the Report
Clicking the Go To Next Scan button repeats this process for the remaining scans. When the final scan is viewed, the Go To Next Scan button changes to Add Recommendations. At this point the content of the various report sections are filled in.
- Report sections are filled in, some automatically. (click for full size)
The Summary screen can show a variety of optional report sections. In the above example:
- The Comparison To Prior Studies section gives a verbal description of change.
- The Assessment section gives the interpretation.
- The Current and Past Treatments section lists treatments as entered on the electronic questionnaire. We did not discuss the questionnaire much during this article. Note that it is available throughout the review process via the Questionnaire link.
- Next visit is the suggested followup.
- FRAX Results is the fracture score. In the above example a FRAX score was not calculated because the patient is osteopenic.
- Comments provides for general comments.
Note that there are drop down menus with many sections. These contains macros of frequently used phrases that may be easily entered in to the report. The physician can also manually enter information into any section.
This was a brief overview of the review process. Many features, such as the integration into EMR systems, were not described or were only touched upon to keep the article short. If you would like to learn more, feel free to contact us. Of course we are happy to hear from you if you have specific topics you’d like covered in future articles. Thank you.