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