DXA Reporting With Dictation: 3 Problems

February 2, 2023 — Mike

Introduction

Not much has changed in the dozen years since we wrote about DXA and PACs. Dictation is still a widely used tool, along side PACS, in reading bone density scans.

There are better ways to read DXA scans that minimize errors and produce better reports.

We have observed three problems with dictation that can easily be solved with a modern solution, such as BoneStation.

Errors capturing DXA data

A DXA body density scan produces quantitative data, including clinically BMD, T-score, and Z-score. DXA readers will typically dictate these values to a report along with an interpretation.

The dictation process is a source of error.  Research has found speech recognition software error rates of at least 7%.

Using modern tools, such as BoneStation, there is no need to dictate this information.  BMD data can be captured automatically from the DICOM transmission of the scan. We talk about this in this blog post.

Tedious To Dictate Elements of a Good DXA Report

There are many components to a high quality bone density report, beyond the BMD data mentioned above. The International Society of Clinical Densitometry (ISCD) defines elements of a bone density report in its recommendations.

It is tedious for many readers of BMD scans to dictate all the elements of a high quality report. Often times this information is omitted. Items such as DXA machine make and model, FRAX risk factors, change in BMD and other clinically relevant information will be lacking from reports.

Time Consuming to Perform Calculations

It can be time consuming for a DXA reader to calculate useful BMD related values, such as change in BMD with prior scan, change in BMD with baseline, and least significant change (LSC).

Automated reporting software, such as BoneStation, can easily produce reports with change in BMD and LSC. In addition, BoneStation can automatically fill in other relevant data, such as DXA machine make and model, FRAX score, FRAX, risk factors, etc.

See our video on ISCD Report Compliance and BoneStation produced reports

Conclusion

Dictation is a widely used method to produce bone density reports today. It is fraught with problems, many of which also apply to transcription and templates. More modern methods exist, that can reduce errors while simultaneously improving quality and efficiency.

Posted in Bone Density Reporting. Tags: , , , , , . Leave a Comment »

Rules of Interpretation

May 17, 2021 — Mike

BoneStation is a web-based reporting system for DXA based bone densitometry. In many of our blog posts we mention that BoneStation requires no transcription and no dictation. That is because BoneStation automatically generates a suggested assessment.

What is meant by that? How does it work?

BoneStation combines three inputs:

  • DXA Scan Data – The bone mineral data from the DXA scan
  • Patient Data – Information about the patient
  • Questionnaire – Online questionnaire that is built into BoneStation

The scan data, patient info, and questionnaire answers are fed into a rules engine. The engine outputs the assessment text, which is displayed to the reading physician as a suggested assessment. The reading physician can accept the assessment or alter it.

A simple set of rules may look like this, where the T-score and Z-score are the lowest values for all measured sites:

The above rules make use of information that is available from just the DXA scans (T-score and Z-score) and patient (age). One common variation on this set of rules is to incorporate the gender and menopausal status of women. The rules can be adjusted to look like this, where the menopausal status is indicated on the questionnaire.

BoneStation is very flexible. The questionnaire, rules, and (output) assessment text are all customizable. Some BoneStation customers’ rules consist of more than 50 rules when factoring in fractures (VFA) and other patient conditions.

Here are some sample questionnaires:

In our next blog post we’ll look at how fractures and VFA can be factored into the above rules.

Posted in Bone Density Reporting. Tags: , , , , , , . Leave a Comment »