Skip to main content
SpringerLink
Log in

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

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Consensus Development Conference (1993) Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

    Article  Google Scholar 

  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):23–57

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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):1033–1046

    Article  CAS  PubMed  Google Scholar 

  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. Blake GM, Fogelman (2007) Role of dual-energy x-ray absorptiometry in the diagnosis and treatment of osteoporosis. J Clin Densitom 10(1):102–110

    Article  PubMed  Google Scholar 

  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):257–260

    Article  PubMed  Google Scholar 

  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):281–286

    Article  PubMed  Google Scholar 

  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):616–619

    Article  CAS  PubMed  Google Scholar 

  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. Watts NB (2004) Fundamentals and pitfalls of bone densitometry using dual-energy x-ray absorptiometry (DXA). Osteoporos Int 15(11):847–854

    Article  PubMed  Google Scholar 

  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):203–210

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Hologic (2000) QDR series user’s guide. Hologic, Bedford

    Google Scholar 

  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):983–988

    PubMed  Google Scholar 

  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):253–257

    Article  PubMed  Google Scholar 

  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 135:182–188

    Article  CAS  PubMed  Google Scholar 

  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 60:837–842

    CAS  PubMed  Google Scholar 

  17. Preidler KW, White LS, Tashkin J et al (1997) Dual-energy x-ray absorptiometric densitometry in osteoarthritis of the hip. Acta Radiol 38:539–542

    CAS  PubMed  Google Scholar 

  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):430–433

    Article  CAS  PubMed  Google Scholar 

  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):724–728

    Article  PubMed  Google Scholar 

  20. Lekamwasam S, Lenora RS (2003) Effect of leg rotation on hip bone mineral density measurements. J Clin Densitom Winter 6(4):331–336

    Article  Google Scholar 

  21. US Preventive Services Task Force (2011) Screening for osteoporosis: US Preventive Services Task Force recommendation statement. Ann Intern Med 154(5):356–364

    Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milano, Italy

    Carmelo Messina, Michele Bandirali & Nathascja Katia D’Alonzo

  2. Unità di Radiologia, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy

    Luca Maria Sconfienza, Giovanni Di Leo, Giacomo Davide Edoardo Papini & Francesco Sardanelli

  3. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Morandi 30, 20097, San Donato Milanese, Italy

    Luca Maria Sconfienza & Francesco Sardanelli

  4. Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina Nucleare, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, via Francesco Sforza 9, 20122, Milano, Italy

    Fabio Massimo Ulivieri

Authors
  1. Carmelo Messina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Bandirali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Maria Sconfienza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nathascja Katia D’Alonzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Di Leo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giacomo Davide Edoardo Papini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabio Massimo Ulivieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Sardanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carmelo Messina.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Messina, C., Bandirali, M., Sconfienza, L.M. et al. Prevalence and type of errors in dual-energy x-ray absorptiometry. Eur Radiol 25, 1504–1511 (2015). https://doi.org/10.1007/s00330-014-3509-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3509-y

Keywords

Search

Navigation