[Fwd: Re: IHE Reporting Task Force Meeting - bone density addition?]

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Christopher Carr

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Oct 27, 2006, 11:20:16 AM10/27/06
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-------- Original Message --------
Subject: Re: IHE Reporting Task Force Meeting - bone density addition?
Date: Fri, 27 Oct 2006 10:11:12 -0500
From: Wal...@mir.wustl.edu
Reply-To: Wal...@mir.wustl.edu
To: Christopher Carr <cc...@rsna.org>
CC: andrei....@dynamic-imaging.com,barry...@mortara.com, br...@medicalmicrographics.com,cal...@merge-efilm.com,cc...@rsna.org, christoph...@ge.com,cor....@philips.com,crey...@hologic.com, dcl...@dclunie.com,dgeorgi...@partners.org,drob...@cerner.com, d...@radiology.northwestern.edu,eliezer...@kodak.com, gsm...@partners.org,harry....@med.ge.com, ihe-re...@googlegroups.com, IHE Cross Domain Cochairs <iheco...@rsna.org>,ihem...@rsna.org, IHE Radiology Planning Committee <ihe...@rsna.org>,ihe...@rsna.org, ITI Tech <iti...@rsna.org>,john.p...@guardiantechintl.com, kev...@tamri.com,nikolau...@siemens.com,paul....@fujimed.com, paul.s...@agfa.com,pcc...@rsna.org,rnou...@ele.etsmtl.ca, rober...@agfa.com,sja...@gmail.com,smu...@wakerad.com, tsi...@acc.org


Just to throw one more exam in to the reporting pot --

Bone densitometry studies are the bane of reporting in many departments. The report includes MANY numerical values, which are frequently transcribed incorrectly.

In our department we have rigged a system where the numbers are sent via HL-7 from the bone density machine and inserted into a report template. However the HL-7 message is just a free text message (as comments, I believe), and we had to design a custom interface to deal with it.

To give you an idea, all the text in bold below comes from the machine via the free-text HL-7 message , which the opinions in blue are automatically generated by our report interface based on the values sent from the machine.

This would be very arduous to dictate manually. A reporting standard to handle this in a more universal context is needed.

JW


      EXAMINATION:  BONE DENSITOMETRY OF THE SPINE AND HIP
     
      DATE OF STUDY:  10/xx/2006
     
      HISTORY:  39-year-old premenopausal woman with a history of _____
      .  She is being treated with  ___________.
      Evaluate bone mineral density.
     
      FINDINGS (SPINE):  The bone mineral density of L1-L4 was
      assessed by dual-energy x-ray absorptiometry.  The average bone
      mineral density within this region is 0.658 gm/sq-cm.  This is
      3.3 standard deviations below the mean of the average bone
      mineral density for age- and gender-matched subjects (the
      Z-score).  It is 3.5 standard deviations below the mean peak
      bone mineral density in young adults (the T-score).
     
      FINDINGS (HIP):  The bone mineral density of the left hip was
      assessed by dual-energy x-ray absorptiometry.  The average bone
      mineral density within the total hip region is 0.571 gm/sq-cm.
      This is 2.9 standard deviations below the mean of the average
      bone mineral density for age- and gender-matched subjects (the
      Z-score).  It is 3.0 standard deviations below the mean peak
      bone mineral density in young adults (the T-score).
     
      SUMMARY OF CURRENT RESULTS:
      -----------------------------------------------------------------
                                             T-     Z-
      Region              Exam Date   BMD    Score  Score
      -----------------------------------------------------------------
      AP Spine(L1-L4)     10/xx/2006  0.658   -3.5   -3.3
      Total Hip(Left)     10/xx/2006  0.571   -3.0   -2.9
     
      COMPARISON WITH PREVIOUS EXAMINATIONS:
      -----------------------------------------------------------------
      Region      Age     BMD     T-Score   BMD Change     BMD Change
      Exam date         (g/cm2)              vs Baseline    vs Previous
      -----------------------------------------------------------------
      AP Spine(L1-L4)
      10/xx/2006   39    0.658      -3.5      -7.7%#         -6.2%*
      05/xx/2005   38    0.701      -3.1      -1.7%#         -8.4%#
      07/xx/2004   37    0.765      -2.6       7.3%*          5.4%#
      11/xx/2003   36    0.726      -2.9       1.8%#          4.1%*
      11/xx/2002   35    0.698      -3.2      -2.2%#        -11.5%*
      10/xx/2001   34    0.788      -2.4      10.5%#         10.5%#
      10/xx/1997   30    0.713      -3.0
     
      Total Hip(Left)
      10/xx/2006   39    0.571      -3.0      -3.7%          -8.5%*
      05/xx/2005   38    0.624      -2.6       5.3%*         -5.2%*
      07/xx/2004   37    0.659      -2.3      11.2%*          2.8%
      11/xx/2003   36    0.641      -2.5       8.1%*          0.6%
      11/xx/2002   35    0.637      -2.5       7.5%*          1.5%
      10/xx/2001   34    0.627      -2.6       5.9%*          5.9%*
      10/xx/1997   30    0.592      -2.9
     
           * Indicates significant change
           # Denotes dissimilar scan types or analysis method
     
      OPINION:
     
      1) The bone mineral density of the lumbar spine is markedly
      decreased and indicative of osteoporosis by WHO criteria.  There
      has been a statistically significant decrease in bone mineral
      density since the baseline examination of 10/xx/1997.
     
      2) The bone mineral density of the left hip is moderately
      decreased and indicative of osteoporosis by WHO criteria.  There
      has been no significant change in bone mineral density since the
      baseline examination of 10/xx/1997.
     
     
      General comments regarding interpretation of bone mineral
      density measurements:  In premenopausal women and males under age 50
      not at increased risk for fracture, only Z-scores, not T-scores are
      used to indicate risk.  A Z-score of -2.0 or lower is defined as
      "below the expected range for age" and a Z-score above -2.0 is "within
      the expected range for age."  Z-scores are also used for comparison
      purposes in children in conjunction with pediatric data bases of bone
      density.
     
      The National Osteoporosis Foundation (www.nof.org) recommends
      adequate intake of calcium and vitamin D and regular
      weight-bearing exercise in all patients.  In Caucasian
      postmenopausal women, the NOF recommends treatment with
      pharmacologic therapy if the T score is below -2.0.  Treatment
      might also be considered if the T-score is between -1.5 and -2.0
      in patients who are at higher risk (e.g., personal history of
      fracture as an adult, history of fragility fracture in a
      first-degree relative, low body weight (< about 127 lbs),
      current smoking, or use of oral corticosteroid therapy for more
      than 3 months).  Guidelines for treatment of osteopenia alone in
      other racial groups, men, and premenopausal women are not
      available, but treatment should definitely be considered if the
      bone density reaches the level of osteoporosis (T-score below
      -2.5).


-- 
Christopher Carr
Director of Informatics/RSNA
820 Jorie Boulevard/Oak Brook, IL 60523
ph: (630)368-3739/fax: (630)571-7837
email: cc...@rsna.org
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