ARRS 2022 Abstracts


E1812. How Not to Crack while Reading DXA: A Primer for the Radiology Resident for Interpretation and Quality Control
  1. Megan Mercer; Medical University of South Carolina
  2. Jonathan Revels; University of New Mexico
  3. Lisa Blacklock; University of New Mexico
  4. Shana Elman; University of New Mexico
  5. Saeed Elojeimy ; Medical University of South Carolina
Dual-energy x-ray absorptiometry (DXA, formerly known as DEXA) is used to assess bone mineral density for purposes of fracture-risk assessment and stratification. Routinely, analysis of the lumbar spine, hip, and/or forearm is performed. One of the limitations of DXA is that its accuracy is highly dependent on both the technologist and the radiologist; the technologist’s skill in acquiring and processing the data and the radiologist’s expertise in interpreting the study are both critical. Because there are multiple potential pitfalls, and precise measurements are needed, it is important for radiologists to be able to provide astute assessment of DXA studies, observing for common technical issues. Our goal is to provide an overview of quality imaging, processing, and troubleshooting techniques for DXA scans, by highlighting common pitfalls.

Educational Goals / Teaching Points
The goal of this presentation is to provide the radiology resident with an overview of quality DXA evaluation, by reviewing technical errors that may be encountered during the acquisition, processing, and interpretation of DXA images. We review several types of potential error, including incorrect placement of the region of interest (ROI), improper positioning of the patient during imaging, miscalculation of fracture risk, and lack of consistency between studies and/or scanners.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Through cases and instructional slides, radiologists in training learn to identify appropriate regions of interest, properly assess fracture risk score, evaluate for appropriate patient positioning, and identify potential limitations in comparison of studies. Potential treatment implications of acquisition and interpretation errors are also discussed.

DXA is a common and routine imaging study, but close attention must be paid to several metrics to provide consistent quality assessment of bone mineral density for patients. Failure to understand appropriate imaging and evaluation may result in errors and misdiagnosis. This presentation is designed to equip trainees to review DXA scans with discerning eyes.