DEXA Protocol (rev. 2/3/2014)
1) Every patient must have a fully completed DXA questionnaire.
2) Know your DXA machines maximum weight capacity at your site and do not exceed it.
3) Each patient shall disrobe fully and be placed into a gown prior to scanning.
4) Remove all artifacts, if possible, prior to scanning (i.e. naval rings, bra clips, coins, buttons/snaps, etc)
5) Each patient shall have their weight and height taken by the technologist/nurse prior to scanning and entered into the DXA unit.
6) Make certain that the patient's age, sex, ethnicity and historical data are accurate and entered as appropriate into the DXA system.
7) Every patient should be scanned in "FAST ARRAY" mode as the primary mode of choice for both initial scans and follow up scans.
8) "ARRAY" mode and/or "EXPRESS" mode may be used, if needed only in those patients where you would not otherwise be able to complete the scan satisfactorily. (i.e. large patients where it is hard to see the site being analyzed, patients who can't hold still for the time necessary to complete scan etc.)
9) THREE valid/acceptable sites are required (if possible) for each DXA scan.
10) The spine and both hips (if able/valid) are the primary sites to be evaluated on every patient.
11) Lateral vertebral morphology should be performed on each patient every time.
12) If there is a primary site that is considered invalid for any reason, (patient can't hold still, severe scoliosis, significant DJD, prior surgery, metal objects, patient overweight for table etc.) scanning of the non-dominant forearm must be performed to allow for a total of THREE valid sites to be evaluated.
13) If the patient has had prior fracture of their non-dominant forearm, then scan the dominant forearm.
14) If more than one primary site is considered invalid, then both forearms should be scanned to allow for a total of THREE valid sites to be evaluated.
15) If an artifact is present involving the spine at one vertebral level and it can't be removed (i.e. naval ring, surgical screw/plate etc.) then that vertebral level should be eliminated from the scan and the remaining vertebrae should be analyzed and averaged together for interpretation. In this case, the non-dominant forearm should also be scanned and submitted for interpretation.
16) If the patient offers a confirmed history of hyperparathyroidism they must have both forearms scanned in addition to our standard three primary site protocol.
17) If the spine or hip(s) can't be scanned for any reason (patient can't hold still, severe scoliosis, significant DJD, prior surgery, metal objects, patient overweight for table etc.) a note must be provided to explain this in Synapse under the "Notes" tab and/or call the reading PA.
18) Make certain that you perform a direct comparison to the most recent DXA scan for every anatomical area scanned before.
19) FRAX analysis should be performed when applicable on each scan.
20) Assure that all paperwork is filled out and this info is scanned into the system properly.
21) End and send all DXA scans efficiently.
22) Direct comparison of DXA scans from centers that have different DXA models, software and/or have not been cross calibrated should not be performed, as the precision error is too great for comparative data to be meaningful.
23) If a patient is being referred for Pediatric (<18 years old) Bone Density Testing or Body Mass Index (BMI) Analysis, please refer the ordering office/patient to the SPHP Washington Ave. DXA site.