Throughout my career as a bone density technologist and a bone density technologist instructor for multiple organizations, I am consistently astounded by the number of technologists performing bone density scans who have never received professional training on how to run the bone density scanner and analyze the bone density scans (also called DXA scans). To make matters worse, I have had conversations with individuals performing DXA scans who have never had any healthcare training nor taken any healthcare class in their entire lives. I don’t know about you, but this is appalling to me. What kind of healthcare office has non-qualified individuals performing radiological medical diagnostic exams? There should be none.
Did you know multiple studies from around the world have shown, depending on the study, that 40 percent up to 90 percent of DXA scans when reviewed by bone density professionals were found to have errors either in the scanning procedures, analysis process, or interpretation from the physicians? This is inexcusable. No one should be performing DXA scans without the proper medical training to include anatomy, physiology, radiation protection training, x-ray physics, and of course an ASRT and ARRT approved bone density course.
Everyone who reads this should be shocked by now. Osteoporosis is a serious disease that, if not accurately diagnosed, patients might not be properly treated and could potentially deal with multiple fractures throughout their life that could have been prevented if put on the correct intervention. Even worse, patients could be prescribed a long-term intervention when it is not needed. I personally have seen this many times because the physicians did not understand the results of the DXA. They didn’t bother to get educated; instead, they assumed they understood what the results meant.
I know when I go to see my doctor and they send me to the lab, I want a phlebotomist that knows what they are doing so I only have to be stuck with a needle once. How about you? This should be the case every time we get an exam; we should expect the best qualified professional around performing our procedure. Unfortunately, this is not happening everywhere in the bone density world. Although I believe it is getting better, there are still many unqualified and uneducated individuals performing DXA scans.
It is important to understand that Dual-Energy x-ray absorptiometry is a diagnostic radiological imaging procedure that now has laws in place in most states requiring professional training. Most states require a minimum of four hours of radiation protection training, 16 hours of bone density training and passing the ARRT or ISCD bone density registry.
Frequent errors that I encounter as I review other DXA scans can be broken into two parts: the actual scan and the scan analysis. Errors I see from the actual scan are artifact errors. For example, I consistently see bra underwires and clasps, buttons and rivets from pants, and body piercings. All these things, even if not seen in the regions of interest, could possibly affect the results of the DXA scan. Errors I have observed related to DXA scan analysis include not placing the region of interest lines in the correct region especially in the lumber spine scan. The most disturbing error I have witnessed in scan analysis happened when the technologist just skipped the analysis all together because they assumed the machine analyzes the scans correctly and did not need correction. A good technologist knows that every DXA scan needs analysis.
The final error that many inexperienced technologists don’t know about is scan mode. With Hologic, I’ve noticed the technologists typically scan all their patients in express mode. If you are a Hologic user, Fast Array or Array should be your target modes. Express Mode should only be used in special circumstances. As for GE users, you have the ability to change the scan mode. If the area being scanned has bone missing, an inexperienced DXA technologist will try to fill in the missing bone when the technologist should change the scan mode from standard-to-thin or thick-to-standard and re-scan the patient. These are just a few of the common errors I have seen throughout my career. There are many more.
Finally, it is important to remember that DXA scanning can be extraordinarily complex, and there is much more to it than a non-trained technologist would expect. If you don’t have an effective quality assurance and control program with detailed protocol at your site as well as registered DXA technologist, I can almost guarantee your site has many falsely diagnosed exams. Thankfully, Advanced Health Education Center has a great bone density two-day initial training course you can sign up for today.
