Bone Density Test Errors: DXA Case Study #1
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- čas přidán 28. 04. 2020
- I'm a bone specialist and I've been studying bone and working with people with osteoporosis and bone density tests for over 25 years. I myself have osteoporosis. I'm interested in making sure people are diagnosed properly. Bone density test mistakes can result in people getting put on medication they don't need, or thinking something that they're doing in an exercise is improving their bone density when it's not.
I am a bone density technologist with an RT degree. I have been doing them correctly. But I did learn some thing about where the placement should be on the femur. It looks like we are placing the line just below the lesser trochanter. Sometimes because of anatomy the computer automatically moves it way up and I have to slide it down. It’s very important for people to get their bone density scans done from the same facility and the same technologist if possible to avoid the errors that you were talking about. I completely agree that technologist should be at least bone density certified.
Good to get your perspective & even better to know that you CARE!! Peace & Good Will to You!!✌
I believe these errors happened to me. 2 years ago, DEXA scan showed I didn’t need treatment and I just went back in this January and the tech said, oh wow, you have really declined and so she went back to previous test to compare and just shrugged her shoulders, saying oh well that scan must of been wrong! I lost confidence in their testing right there and the tech’s attitude, oh well, doesn’t help me
Dr. Simpson, thank you so much for the information. It is critical that proper training is needed, and I am happy to review these videos for learning purposes. I now have more confidence about analysis to provide to doctors the very best information I can. THANK YOU, AGAIN! D
Thank you very much,highly appreciated.
Good to know!! To be perfectly honest, EVERY time I have to see a doctor or am sent for a test I tend to fret. MISTAKES happen, and in the medical profession, they happen a LOT - Now more than ever, because they are short staffed, and simply don't have time to CARE, while the drug companies make a killing out of SCARing in stead, by running all kinds of ads. telling people they might be at risk for this & that!! I've also noticed that if a person is normally HEALTHY & not over weight, (here in the US) they are in a different category these days, because the general "one size / attitude fits all" going, puts us in a different "rare species" category!? I practice listening to my body, Wholistic Health, Yoga, precaution over cure, vitamins over meds., use moderation & common sense, and am in good health - but anything unusual on my yearly exam scares the crap out of me. I usually avoid extra / unnecessary tests but go for what's needed. A Bone Density is required, as I'm experiencing occasional aches & pains in my aging joints, so I'm having one done, just to know. IF PROBLEMS SHOULD SHOW IN MY TEST, I WILL BE SURE TO GET A SECOND OPENION FROM AN EXPERT, RATHER THAN RELY ON WHAT'S SAID. THANKS FOR THE INFO!! 🙏Namaste From USA!!
Thank you. Very informative.
It's very helpful. Thank you.
Wow. I picked up on that idea. In some offices "nobody actually looks at the scans". I guess I will have to ask in the office where I go if that's the guess.
Yikes...! I just had a Dexa Bone Density Test done today. My last test was done in 1994 at the age of 36. I'm 64 years old now. Awaiting my report which will be ready in about 8 days.
Thank u for the case study ,it was informative.
If u have a case study for SMA patients specially kids it would be helpful
Thank you 🙏
The technologist is not supposed to draw in the missing bone unless the area is greater than the default curser size according to the GE Lunar User Manual
According to the ISCD, the DXA error rate is very high. 90% of all DXA performed in the United States are hit with at least one error. Messina et al, Eur Radiol 2015. Most commonly it is a degenerative disease causing an elevation of BMD gm/cm2 and therefore a falsely elevated T-score. We are learning more about trabecular bone and our antithetic precision of Tscore systems with QCT comparisons. The bigger issue at large is dose vs cost. Prevention is the way.
I always order the spine the femur and the forearm DXA. From that, as a densitometrist I can get a pretty good idea of the density. TBS adds to the bone health picture as does lab testing. You are absolutely correct that prevention is the way. Unfortunately, I had no clue in my teens when I was building bone. Prevention starts in the womb and especially through the heavy bone building years of puberty. I was diagnosed with osteoporosis in my 40s and the people I deal with already have it, they can’t go back to change it. I’m in they have sustained horrendous fractures. That said, I have never fractured nor have I been on a bone drug other than low-dose estradiol, and a healthy diet since my 20s. There’s so much to know and understand about bone And the vast majority of doctors simply do not have the knowledge base for them to assess an individual set of bones. In my case, I think I lucked out genetically to some extent.
I am fortunate with my past that I have not fractured and likely I was lucky regarding certain genes. Genes play a big role too, As does nutrition, digestive health and exercise
Why do we leave the ischium in the region of interest? If we can remove it from the bone map to position the neck box, why is it included at all in the bone map?
Dr. Lani,
I have Harrington Rods in my back and just had DEXA. Is it going to be distorted? Should I have had it done. The technician said it was ok.
depends on which part of the spine. as long as there are two viable vertebral bodies to take measurements from, the spine can be used for diagnostic purposes.
They should also test the forearm - for all cases where the lumbar or a femur is compromised. I always order the forearm regardless
Hello how protocol do you use for doing It?
Kv? Milliampere?
Dr Lani. My 77 year old mother recently had her Dexa done with Left Hip and Lumbar Spine(L1 - L4)
The total T-score of the lumbar spine is (-5.4).
The T-score of the Left hip is (-3.0).
After seeing your excellent video i am confused for the correct imaging done for the Dexa , because with T-score of < - 2.5(osteoporosis), i have been told to use Aclasta(zoledronic Acid) for my mother, which i don't know will be helpful for her.
We are in an Asian Country, so could you please let me know a means to connect with you(Email etc) to send you the scans. I really appreciate that. Thanks
Email my assistant sallysimpsonoffice@gmail.com regarding setting up an appt to have them read.
Dr. Simpson, my doctor refuses to order the dexa scan for me every year, just wondering where can I order it myself?
Unless you have an expected 5% loss or gain there is no point in having a bone density test yearly. Typically, it’s every two years. Exceptions to that are if I only have one bone density test diagnosed as osteoporosis I may want to order one in a year, to help determine whether or not active loss is occurring. That said, lab work fills out the story including bone turnover markers. If you are interested in learning more in depth regarding bone Health, check out my master class on my website
Mam... If wrong age gets entered... Will that have affect on results
As a patient who recently had my second bone density test at the same facility, am I able to see the screenings and do a visual check to know if the reports are correctly taken?
Ask for the full report including the images. I am a densitometrist and of course I see things you would not see. That said, give it a try. Also, I do offer second opinions regarding DXAs
thank you@@DoctorLani
I had a L5 S1 fusion since my last dexa, the tech did do an added foream to my scan a few days ago. Results of scan show worsening spine but improved hip. Should I question this? The tech did call in someone to look at the images while I was being scanned because she felt like the hardware may have been causing an issue? It was done at a radiology center on the same machine used 3 years ago. I was told recently
I have a mild thoracic scoliosis since last scan as well. 11% decrease in lumbar!?
No way for me to know unless I reviewed the scans. If you did lose 11% in three years that is very significant. Bone turnover markers - CTX and P1NP would be helpful and also, if true other tests to see if there is a cause. You should get a second opinion on the scans. I offer (see my website) and others do as well.
The square should look like a square not a rectangle… I have a question Doctor the little square that’s in the neck rectangle where should be placed?? And what is it for?
The square is referred to as Ward's triagle oddly. It is not reproducable. It is the place that the DXA machine selects as the lowest bone density. For densitomitrists, that do a full analysis we will look at this area and the trochanter, which is mixed bone. Femur neck is mostly compact bone and lumbar spine cancellous, 33% forearm iscompact bone
How do I know if my scan has been read correctly?
I think the main problem is to be done correctly and consistently
Im being sent for one of these. Not scheduled yet.
Following a knee x-ray where I was just diagnosed with osteoporian, and some type of narrowing due to knee pain, and limited range of motion, and a possible old femur fracture was noted, as well as post changes, and other things, following an oblique fracture of the femur incured while being hit from behind, by an SUV while crossing in acroos walk last Christmas Eve of which I have not recoverd near to my full acpacity of walkingg orovement and feeling of my legs, feet, and toes.
Due to these issues witb my lower extremities low back xrays were also done which showed a fracture of L -5 whatever that means, and maybe otber things. I can post the remarks here if need be. I am just having trohble thinking all these thing are wrong since and acter I had jusyveen hospitaized for months and had surgery, and no one notice this sixmonths ago. Can it come on this fast?
And whT is it and what does it mean foe me exactly? And 2hat should do or ot do since hou have thia yourself?
Thank you