Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

Karahan, Ali Yavuz; Kaya, Bugra; Kuran, Banu; Altındag, Ozlem; Yildirim, Pelin; Dogan, Sevil Ceyhan; Basaran, Aynur; Salbas, Ender; Altınbilek, Turgay; Guler, Tuba; Tolu, Sena; Hasbek, Zekiye; Ordahan, Banu; Kaydok, Ercan; Yucel, Ufuk; Yesilyurt, Selcuk; Polat, Almula Demir; Cubukcu, Murat; Nas, Omer; Sarp, Umit; Yasar, Ozan; Kucuksarac, Seher; Turkoglu, Gozde; Karadag, Ahmet; Bagcaci, Sinan; Erol, Kemal; Guler, Emel; Tuna, Serpil; Yildirim, Ahmet; Karpuz, Savas

doi:10.14712/18059694.2017.38

Acta Medica > Archive > 2016, Vol. 59 > Issue 4 > Common Mistakes in the Dual-Energy X-ray…

Acta Med. 2016, 59: 117-123

https://doi.org/10.14712/18059694.2017.38

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

Ali Yavuz Karahan^a, Bugra Kaya^b, Banu Kuran^c, Ozlem Altındag^d, Pelin Yildirim^e, Sevil Ceyhan Dogan^f, Aynur Basaran^a, Ender Salbas^g, Turgay Altınbilek^h, Tuba Guler^e, Sena Toluⁱ, Zekiye Hasbek^j, Banu Ordahan^a, Ercan Kaydok^k, Ufuk Yucel^k, Selcuk Yesilyurt^l, Almula Demir Polat^m, Murat Cubukcuⁿ, Omer Nas^o, Umit Sarp^o, Ozan Yasar^p, Seher Kucuksarac^a, Gozde Turkoglu^a, Ahmet Karadag^q, Sinan Bagcaci^r, Kemal Erol^s, Emel Guler^t, Serpil Tuna^u, Ahmet Yildirim^v, Savas Karpuz^a

^aDepartment of Physical Medicine and Rehabilitation, Beyhekim State Hospital of Konya, Konya, Turkey
^bDepartment of Nuclear Medicine of Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
^cDepartment of Physical Medicine and Rehabilitation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
^dDepartment of Physical Medicine and Rehabilitation, Gaziantep University Sahinbey Research and Training Hospital, Gaziantep, Turkey
^eDepartment of Physical Medicine and Rehabilitation, Derince Training and Research Hospital, Kocaeli, Turkey
^fDepartment of Physical Medicine and Rehabilitation, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
^gDepartment of Physical Medicine and Rehabilitation, State Hospital of Agri, Agri, Turkey
^hDepartment of Physical Medicine and Rehabilitation, Physical therapy High school of Health Sciences of University of Halic, Istanbul, Turkey
ⁱDepartment of Physical Medicine and Rehabilitation, Medipol University, Faculty of Medicine, Istanbul, Turkey
^jDepartment of Nuclear Medicine, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
^kDepartment of Physical Medicine and Rehabilitation, State Hospital of Nevsehir, Nevsehir, Turkey
^lDepartment of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Hospital of Yoncali, Kutahya, Turkey
^mDepartment of Physical Medicine and Rehabilitation, State Hospital of Afyon, Afyon, Turkey
ⁿDepartment of Physical Medicine and Rehabilitation, State Hospital of Denizli, Denizli, Turkey
^oDepartment of Physical Medicine and Rehabilitation, State Hospital of Yozgat, Yozgat, Turkey
^pDepartment of Physical Medicine and Rehabilitation, Amasya University Sabuncuoglu Serefeddin Research and Training Hospital, Amasya, Turkey
^qDepartment of Physical Medicine and Rehabilitation, State Hospital of Sivas, Sivas, Turkey
^rDepartment of Physical Medicine and Rehabilitation, State Hospital of Hakkari, Hakkari, Turkey
^sDepartment of Physical Medicine and Rehabilitation, State Hospital of Nigde, Nigde, Turkey
^tDepartment of Physical Medicine and Rehabilitation, Kayseri Training and Research Hospital, Kayseri, Turkey
^uDepartment of Physical Medicine and Rehabilitation, Akdeniz University, Faculty of Medicine, Antalya, Turkey
^vDepartment of Orthopedics and Traumatology, Beyhekim State Hospital of Konya, Konya, Turkey

Received May 23, 2016
Accepted August 29, 2016

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.