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DXA quality toolkit

Our DXA quality toolkit includes tools to support clinical effectiveness, a set of quality standards for scan acquisition and analysis, tailored to the different DXA scanner manufacturers specifications, and audit tools for scan technique and reporting.

Our tools are designed to help you:

  • establish pathways for prioritising patients to support with waiting list backlogs
  • evaluate scan technique and analysis against standards
  • support quality improvement for scan acquisition and analysis
  • develop reporting processes that are able to meet IR(ME)R regulations regarding clinical evaluation and optimisation

Our vertebral fracture assessment (VFA) focus guides are aimed to further support the identification of vertebral fractures within DXA services.

DXA Prioritisation tool

This tool can support with backlog and waiting list management and enable patients with the highest risk to access a DXA scan in a timely manner, this can support the earlier diagnosis and access to treatments.

Quality standards checklist

This checklist sets out the expected standards for optimal DXA scan positioning and analysis of the lumbar spine and proximal femur for the two main manufacturers equipment in use in the UK.

It is designed for DXA teams to be able to:
• Support precision error reduction and promote reliability of measurements
• Write and develop local standard operating procedures for scan acquisition
and analysis
• Measure performance against the standards and integrate with quality
improvement programmes
• Support delivery of quality improvements in DXA scanning technique
• Use in conjunction with the ROS DXA scan technique audit tool

Audit tools

Use our audit tools to understand how well your service is performing against the quality standards and find opportunities for quality improvement. 

These can be used as part of routine clinical audit and quality improvement cycles, and can be adapted for your department's needs.

This tool helps to evaluate the quality of DXA scan technique by mapping performance against the ROS DXA scan quality standard checklist.

This tool includes:

  • audit protocol
  • data collection sheet
  • audit reporting and action planning template
  • DXA scan technique standards
  • longitudinal monitoring tool

To use this tool, you'll need to be confident in assessing DXA scan images and have access to your DXA scanner to view scans.

This tool can help you to:

  • understand how DXA reporting at your centre meets the reporting standards 
  • benchmark your service and identify areas for improvement
  • formulate an action plan to support the clinical governance and effectiveness in the reporting of DXA scans
  • meet IR(ME)R audit requirements around clinical evaluation

It includes:

  • audit protocol
  • data collection sheet
  • audit reporting template
  • DXA reporting standards

VFA 

The VFA focus guides set out example referral and acceptance criteria for VFA scanning within DXA services which a drawn from UK and international referral guidelines. They also set out practical steps to acquiring and analysing VFA scans so that these are reliable and consistent to enable effective identification of vertebral fractures in clinical practice, both as opportunistic and planned cases.

This guide sets out suggested referral and acceptance criteria for VFA scans, in patients that may be at risk of vertebral fragility fracture, as planned or opportunistic scans in a DXA service.

It is designed for DXA teams to be able to:
• Write and develop local referral acceptance criteria for VFA scans
• Support improvements for the identification of people at risk of vertebral fragility fractures
• Optimise resource in offering VFA scans to those who would most benefit
So that:
People with suspected and asymptomatic vertebral fractures are identified sooner, and people with very low BMD may access a wider range of bone protective therapies and reduce the risk of further fractures.

NB: Referral criteria are the responsibility of the IR(M)R Practitioner
and are detailed in local IR(ME)R Employers Procedures as part of
justification and authorisation under protocol

This guide sets out the expected standards for optimal VFA scan positioning.

It is designed for DXA teams to be able to:
• Make reliable VFA scans
• Write and develop local standard operating procedures for scan acquisition
• Measure performance against the standards and integrate with quality improvement programmes
• Support delivery of quality improvements in VFA scanning technique

So that:
VFA scans are optimised and provide the best opportunity to identify vertebral fractures in appropriate patients and that they can access appropriate care to reduce the risk of further fractures.

This guide sets out the expected standards for optimal VFA analysis.

It is designed for DXA teams to be able to:
• Provide reliable VFA clinical evaluation and reports
• Write and develop local standard operating procedures for scan acquisition and analysis
• Measure performance against the standards and integrate with quality improvement programmes
• Support delivery of quality improvements in VFA analysis technique

So that:
VFA scans are optimised and provide the best opportunity to identify vertebral fractures in appropriate patients and that they can access appropriate care to reduce the risk of further fractures

This focus guide is developed from the ROS National Training Scheme for Bone Densitometry lecture course and VFA scan protocols from clinical services.

Our toolkit is supported* by:

*UCB has provided financial support for this work but has not input to or influenced its development or content.

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