Improving DXA Quality by Avoiding Common Technical and Diagnostic Pitfalls: Part 1

Dual-energy x-ray absorptiometry (DXA) is an accurate means to assess bone mineral density, determine the risk of a fragility fracture, and monitor response to therapy. Despite its seemingly straightforward nature—the review of 2-to-3 nondiagnostic images and a few automatically generated numbers—the proper performance and interpretation of DXA can often be complex. It is complex because it is highly dependent on many factors, such as image acquisition, processing, analysis, and subsequent examination interpretation. Each step is subject to potential errors, artifacts, and diagnostic pitfalls; hence, meticulous attention must be paid to the technique by both the technologist and the interpreting physician to provide high-quality results and, in turn, maximize the examination’s clinical utility. This article is part 1 of a 2-part series. Part 1 will begin with a review of bone physiology and osteoporosis etiology, followed by a discussion of the principles underlying DXA and the technical procedure. Part 2 will focus on DXA interpretation and discuss scanning pitfalls and clues to recognizing issues and improving scan quality.