Advertisement

European Radiology

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

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

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

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Acknowledgements

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.

References

  1. 1.
    Consensus Development Conference (1993) Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650CrossRefGoogle Scholar
  2. 2.
    Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Kanis JA, Oden A, Johnell O et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046CrossRefPubMedGoogle Scholar
  4. 4.
    WHO (2007) Assessment of osteoporosis at the primary health care level. Report of a WHO Scientific Group. http://www.who.int/chp/topics/rheumatic/en/index.html. Accessed 21 Jun 2014
  5. 5.
    Blake GM, Fogelman (2007) Role of dual-energy x-ray absorptiometry in the diagnosis and treatment of osteoporosis. J Clin Densitom 10(1):102–110CrossRefPubMedGoogle Scholar
  6. 6.
    Bandirali M, Sconfienza LM, Aliprandi A et al (2014) In vivo differences among scan modes in bone mineral density measurement at dual-energy x-ray absorptiometry. Radiol Med 119(4):257–260CrossRefPubMedGoogle Scholar
  7. 7.
    El Maghraoui A, Achemlal L, Bezza A (2006) Monitoring of dual-energy x-ray absorptiometry measurement in clinical practice. J Clin Densitom 9(3):281–286CrossRefPubMedGoogle Scholar
  8. 8.
    Delnevo A, Bandirali M, Di Leo G et al (2013) Differences among array, fast array, and high-definition scan modes in bone mineral density measurement at dual-energy x-ray absorptiometry on a phantom. Clin Radiol 68(6):616–619CrossRefPubMedGoogle Scholar
  9. 9.
    International Society for Clinical Densitometry (2013) Official positions of the International Society for Clinical Densitometry. http://www.iscd.org/official-positions/2013-iscd-official-positions-adult/. Accessed 21 Jun 2014
  10. 10.
    Watts NB (2004) Fundamentals and pitfalls of bone densitometry using dual-energy x-ray absorptiometry (DXA). Osteoporos Int 15(11):847–854CrossRefPubMedGoogle Scholar
  11. 11.
    Garg MK, Kharb S (2013) Dual energy x-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab 17(2):203–210CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Hologic (2000) QDR series user’s guide. Hologic, BedfordGoogle Scholar
  13. 13.
    Bachrach LK (2000) Dual energy x-ray absorptiometry (DEXA) measurements of bone density and body composition: promise and pitfalls. J Pediatr Endocrinol Metab 13(Suppl):983–988PubMedGoogle Scholar
  14. 14.
    Gafni RI, Baron J (2004) Overdiagnosis of osteoporosis in children due to misinterpretation of dual-energy x-ray absorptiometry (DEXA). J Pediatr 144(2):253–257CrossRefPubMedGoogle Scholar
  15. 15.
    Leonard MB, Propert KJ, Zemel BS, Stallings VA, Feldman HI (1999) Discrepancies in pediatric bone mineral density reference data: potential for misdiagnosis of osteopenia. J Pediatr 135:182–188CrossRefPubMedGoogle Scholar
  16. 16.
    Prentice A, Parsons TJ, Cole TJ (1994) Uncritical use of bone mineral density in absorptiometry may lead to size-related artifacts in the identification of bone mineral determinants. Am J Clin Nutr 60:837–842PubMedGoogle Scholar
  17. 17.
    Preidler KW, White LS, Tashkin J et al (1997) Dual-energy x-ray absorptiometric densitometry in osteoarthritis of the hip. Acta Radiol 38:539–542PubMedGoogle Scholar
  18. 18.
    Rand T, Seidl G, Kainberger F et al (1997) Impact of spinal degenerative changes on the evaluation of bone mineral density with dual energy x-ray absorptiometry (DXA). Calcif Tissue Int 60(5):430–433CrossRefPubMedGoogle Scholar
  19. 19.
    Muraki S, Yamamoto S, Ishibashi H et al (2004) Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 15(9):724–728CrossRefPubMedGoogle Scholar
  20. 20.
    Lekamwasam S, Lenora RS (2003) Effect of leg rotation on hip bone mineral density measurements. J Clin Densitom Winter 6(4):331–336CrossRefGoogle Scholar
  21. 21.
    US Preventive Services Task Force (2011) Screening for osteoporosis: US Preventive Services Task Force recommendation statement. Ann Intern Med 154(5):356–364CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Carmelo Messina
    • 1
  • 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

Personalised recommendations