Category: Central DXA: (DXA, TBS)

23 - An Interpretation Template Reduces DXA Reporting Errors

Objective: High-quality DXA performance requires excellence in acquisition, analysis and interpretation. However, DXA errors in clinical practice are common and may lead to incorrect clinical decisions. Approaches to improve clinical DXA quality are needed. To this end, we evaluated the effect of implementing a DXA reporting template (adapted from an ISCD model) on DXA error rates at 2 medical centers.


Methods:
We crafted a DXA template that contained standardized text for reporting BMD, T- or Z-score, BMD change over time and impression. The template was implemented at 2 clinical sites. Anonymized DXA images and reports from prior to and following template implementation were independently reviewed by 3 ISCD-certified physicians who assessed compliance with reporting guidance and recorded any errors. Subsequently, these physicians met to reach consensus on each DXA interpretation. Any deviation from ISCD interpretation guidance was labeled an error while major errors were further defined as “provision of inaccurate information that could potentially lead to incorrect patient care decisions.” Following template implementation, 200 scans (20 each from 5 interpreters at site A and 50 each from 2 interpreters at site B) were reviewed.


Results:
Here we report DXA data from 498 patients (mean [range] age 65 [8-94 years], 446 female/52 male); 298 before and 200 after template implementation. Major errors were present in 37% before and 17% after template implementation (Table). Template usage reduced the odds of major error by 66% (odds ratio 0.34, 95% CI 0.21, 0.53, p < 0.0001).
Before and after template implementation, the most common major errors were incorrect information on BMD change and incorrect diagnosis, accounting for 37-69% and 12-21% of errors respectively. After template implementation, incorrect information on BMD change and incorrect diagnosis remained the most common major errors accounting for 25-52% and 19-50% of errors respectively.


Conclusion:
Major errors on DXA reports are extremely common. These errors likely adversely affect patient care. Implementing a DXA interpretation template reduced major errors and should become common practice. As this template did not not entirely eliminate errors, additional interventions, possibly including requiring initial and ongoing DXA training and/or certification, are necessary to provide high quality DXA reports. It seems likely that such efforts will improve osteoporosis care.

Bjoern Buehring

Assistant Professor
University of Wisconsin Osteoporosis Clinical Research Programs
Madison, Wisconsin

Karen Hansen

Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin

Diane Krueger

Research Program Manager
University of Wisconsin Osteoporosis Clinical Research Program
Madison, Wisconsin

Diane Krueger received her Bachelor of Science degree at the University of Wisconsin-Madison. She is an ISCD-certified clinical densitometrist and a certified clinical research coordinator through the Association of Clinical Research Professionals. She has been program manager of the University of Wisconsin Osteoporosis Clinical Research Program since its inception in 1993. Ms. Krueger has extensive clinical research experience in osteoporosis and bone densitometry, having coordinated multiple industry and investigator-initiated studies. In collaboration with the UW Osteoporosis Program, she has published over 70 manuscripts and authored or presented over 100 abstracts. Her service with ISCD has included chairing the Technologist Bone Densitometry Update and Annual Meeting Committees, participating on the Education Council, serving on the Executive Committee and Board as member and officer (Secretary and four Presidential seats). She has been Technologist Bone Densitometry Course faculty since 2006.

Erin Shives

RN
University of Wisconsin Osteoporosis Clinical Research Program
Madison, Wisconsin

Ellen Siglinsky

Research Specialist
University of Wisconsin Osteoporosis Clinical Research Program
Madison, Wisconsin

Neil Binkley

Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin