University of Wisconsin-Madison, Madison, WI, USA.
University of Wisconsin-Madison, Madison, WI, USA.
J Clin Densitom. 2019 Jan-Mar;22(1):115-124. doi: 10.1016/j.jocd.2018.07.014. Epub 2018 Sep 13.
High quality dual energy X-ray absorptiometry (DXA) acquisition, analysis, and reporting demands technical and interpretive excellence. We hypothesized that DXA errors are common and of such magnitude that incorrect clinical decisions might result. In this 2-phase study, we evaluated DXA technical and interpretation error rates in a clinical population and subsequently assessed if implementing an interpretation template reduced errors.
In phase 1, DXA scans of 345 osteoporosis clinic referrals were reviewed by International Society for Clinical Densitometry-certified technologists (n = 3) and physicians (n = 3). Technologists applied International Society for Clinical Densitometry performance standards to assess technical quality. Physicians assessed reporting compliance with published guidance, relevance of technical errors and determined overall and major error prevalence. Major errors were defined as "provision of inaccurate information that could potentially lead to incorrect patient care decisions." In phase 2, a DXA reporting template was implemented at 2 clinical DXA sites after which the 3 physicians reviewed 200 images and reports as above. The error prevalence was compared with the 298 patients in phase 1 from these sites.
In phase 1, technical errors were identified in 90% of patients and affected interpretation in 13%. Interpretation errors were present in 80% of patients; 42% were major. The most common major errors were reporting incorrect information on bone mineral density change (70%) and incorrect diagnosis (22%). In phase 2, at these 2 clinical sites, major errors were present in 37% before and 17% after template implementation. Template usage reduced the odds of major error by 66% (odds ratio 0.34, 95% confidence interval 0.21, 0.53, and p < 0.0001).
DXA technical and interpretation errors are extremely common and likely adversely affect patient care. Implementing a DXA reporting template reduces major errors and should become common practice. Additional interventions, such as requiring initial and ongoing training and/or certification for technologists and interpreters, are suggested.
高质量的双能 X 射线吸收法（DXA）采集、分析和报告需要技术和解释的卓越表现。我们假设 DXA 错误很常见，且其严重程度可能导致错误的临床决策。在这项两阶段研究中，我们评估了临床人群中 DXA 技术和解释错误的发生率，随后评估了实施解释模板是否可以减少错误。
在第一阶段，由国际临床密度测定学会认证的技术人员（n=3）和医生（n=3）对 345 例骨质疏松症诊所转诊患者的 DXA 扫描进行了审查。技术人员应用国际临床密度测定学会性能标准来评估技术质量。医生评估报告是否符合已发表指南的规定、技术错误的相关性，并确定整体和主要错误的发生率。主要错误被定义为“提供可能导致患者护理决策错误的不准确信息”。在第二阶段，在两个临床 DXA 站点实施 DXA 报告模板后，这 3 名医生如上所述审查了 200 张图像和报告。将错误发生率与来自这些站点的第一阶段的 298 名患者进行了比较。
在第一阶段，90%的患者存在技术错误，其中 13%的错误影响解释。80%的患者存在解释错误，其中 42%为主要错误。最常见的主要错误是报告骨密度变化的错误信息（70%）和错误的诊断（22%）。在第二阶段，在这两个临床站点，模板实施前主要错误发生率为 37%，实施后为 17%。模板的使用使主要错误的发生几率降低了 66%（优势比 0.34，95%置信区间 0.21，0.53，p<0.0001）。
DXA 技术和解释错误非常常见，可能会对患者护理产生不利影响。实施 DXA 报告模板可以减少主要错误，应该成为常见做法。建议采取其他干预措施，例如要求技术人员和解释人员进行初始和持续培训和/或认证。
