European Radiology

, Volume 25, Issue 5, pp 1504–1511 | Cite as

Prevalence and type of errors in dual-energy x-ray absorptiometry

  • Carmelo MessinaEmail author
  • Michele Bandirali
  • Luca Maria Sconfienza
  • Nathascja Katia D’Alonzo
  • Giovanni Di Leo
  • Giacomo Davide Edoardo Papini
  • Fabio Massimo Ulivieri
  • Francesco Sardanelli



Pitfalls in dual-energy x-ray absorptiometry (DXA) are common. Our aim was to assess rate and type of errors in DXA examinations/reports, evaluating a consecutive series of DXA images of patients examined elsewhere and later presenting to our institution for a follow-up DXA.


After ethics committee approval, a radiologist retrospectively reviewed all DXA images provided by patients presenting at our institution for a new DXA. Errors were categorized as patient positioning (PP), data analysis (DA), artefacts and/or demographics.


Of 2,476 patients, 1,198 had no previous DXA, while 793 had a previous DXA performed in our institution. The remaining 485 (20 %) patients entered the study (38 men and 447 women; mean age ± standard deviation, 68 ± 9 years). Previous DXA examinations were performed at a total of 37 centres. Of 485 reports, 451 (93 %) had at least one error out of a total of 558 errors distributed as follows: 441 (79 %) were DA, 66 (12 %) PP, 39 (7 %) artefacts and 12 (2 %) demographics.


About 20 % of patients did not undergo DXA at the same institution as previously. More than 90 % of DXA presented at least one error, mainly of DA. International Society for Clinical Densitometry guidelines are very poorly adopted.

Key Points

More than 90 % of DXA examinations/reports presented one or more errors.

About 80 % of errors are related to image data analysis.

Errors in DXA examinations may have potential implications for patients’ management.


Osteoporosis Dual-energy x-ray absorptiometry Bone mineral density Densitometry Pitfalls 



The scientific guarantor of this publication is Dr. Carmelo Messina. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, cross sectional study, performed at one institution.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Carmelo Messina
    • 1
    Email author
  • Michele Bandirali
    • 1
  • Luca Maria Sconfienza
    • 2
    • 3
  • Nathascja Katia D’Alonzo
    • 1
  • Giovanni Di Leo
    • 2
  • Giacomo Davide Edoardo Papini
    • 2
  • Fabio Massimo Ulivieri
    • 4
  • Francesco Sardanelli
    • 2
    • 3
  1. 1.Scuola di Specializzazione in RadiodiagnosticaUniversità degli Studi di MilanoMilanoItaly
  2. 2.Unità di RadiologiaIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  3. 3.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoSan Donato MilaneseItaly
  4. 4.Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina NucleareIRCCS Fondazione Ca’ Granda Ospedale Maggiore PoliclinicoMilanoItaly

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