Dear Blackpool Teaching Hospitals NHS Foundation Trust,

The Royal Osteoporosis Society, in it’s capacity as secretariat for the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health, is making a Freedom of Information Act (FOI) request of all Trusts, Health Boards and Health and Social Care Trusts to assess DXA service provision and facilities.

The All Party Parliamentary Group will hold a hearing later this year on DXA service workforce, infrastructure and quality in the UK. To support the work of the group, Parliamentarians have asked for a Freedom of Information (FOI) request to be circulated to assess the level and quality of provision across the country. This is a positive, solution-focused assessment of how we can improve services for the 3.5m people living with osteoporosis in the UK.

Data will be used to assess how we can target future resources to ensure that all patients receive the highest level of care and that there is consistency of quality across services.

We appreciate your help with this information gathering exercise, especially as we understand the pressures that healthcare services continue to experience.

Please pass the questions below on to your DXA Service delivery lead, manager or clinical lead. If this is not possible, we would appreciate your help to provide as much information as you can.

Yours faithfully,
Craig Jones, CEO, The Royal Osteoporosis Society

Questions:

Infrastructure:

1) Do you outsource your DXA scans? If Yes- please state the organisation providing this service and forward this FOI to your provider for completion (please continue to complete for any of the elements of the DXA pathway that are provided by your Trust/board)

2) In January 2023 how many DXA scanning machines did you have at your trust/board for clinical use?
a. n. Operational
b. n. not in use
c. n. accessible outside of Trust

3) What is the average weekly capacity for clinical scans? (N. of scans per week)

4) What was your average DNA rate over the last 3 months? (n. DNA/total n. scans booked)

5) What age range do you include in your clinical scans? Please tick all that apply
a. <20 years
b. 20-40 years
c. 40-60 years
d. 60-75 years
e. 75-80 years
f. >80 years

6) What is the duration of your routine DXA appointment:
a. 15 minutes or less
b. 16-25 minutes
c. 26-30 minutes
d. >30 minutes

7) What was the average wait for clinical patients from referral to scan in January 2023?
a. <2 weeks (move to Q9)
b. 2-6 weeks (move to Q9)
c. 6-13 weeks
d. >13 weeks

8) What are your perceived barriers to delivering DXA scans within 6 weeks from referral? Please tick all that apply
a. Scanner capacity (DXA equipment)
b. Clinical capacity (operator)
c. Other- please state

9) What was the average time from the scan to the report being available to the referrer in January 2023?
a. <3 weeks (move to Q11)
b. 4-6 week
c. 6-13 weeks
d. >13 weeks

10) What are your perceived barriers to referrers receiving DXA scan reports within 3 weeks from scan? Please tick all that apply
a. Clerical- internal
b. Clinical- internal
c. Factors external to this service (please state)
d. Other (please state)

11) What hospital department is responsible for delivery of DXA scans:
a. Radiology
b. Medical physics
c. Nuclear medicine
d. Rheumatology
e. Other- please state

12) Which DXA examinations are included in routine protocols for the clinical service? Please tick all that apply
a. Lumbar spine
b. Proximal femur
c. Long femur (AFF assessment)
d. Total body
e. Vertebral fracture assessment (VFA)
f. Peripheral/forearm

13) What access facilities do you have available? Please tick all that apply
a. Overhead hoist
b. Portable hoist
c. Wheelchair transfers
d. Bed/trolly transfers
e. Changing room
f. assistance for transfers
g. Other- please state

Workforce:

1)
i) What professional groups perform DXA scan measurements at your center? (DXA operators)
a. Radiographer
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism
g. Other- please state
h. Unknown]

ii) Please indicate WTE for each group selected

2) What DXA-specific training (outside of professional training) have the DXA operators performing scans had?
a. In house
b. Manufacturers applications training
c. Recognized/accredited national training programme (please state the name of the training programme/provider)
d. Other- please state
e. unknown

3) What professional groups report your DXA scans at your center? ()
a. Radiographer - internal
b. Radiographer - external
c. DXA technician – internal
d. DXA technician - external
e. Assistant practitioner – internal
f. Assistant practitioner - external
g. Clinical scientist – internal
h. Clinical scientist - external
i. Nurse -internal
j. Nurse - external
k. Medical Dr – internal - please state specialism(s)
l. Medical Dr – external - please state specialism(s)
m. Other- please state
n. Reporting is outsourced
o. unknown

4) What training (outside of professional training) have those reporting DXA scans had- specifically in DXA reporting?
a. In house
b. Manufacturers applications training
c. Recognized/accredited national training programme (please state the name of the training programme/provider)
d. Other- please state
e. unknown

5) What professional group provides clinical leadership for your service?
a. Radiographer
b. DXA technician
c. Assistant practitioner
d. Clinical scientist
e. Nurse
f. Medical Dr- please state specialism(s)
g. Other- please state
h. unknown

6) Please indicate how many (WTE) clinical vacancies in your DXA service do you have in January 2023? (Free text)

Quality:

1) Is your service accredited as part of a national programme?
a. ISAS
b. IOS
c. Other- please state
d. None
e. Unknown

2) What clinical audits do you routinely undertake? Please tick all that apply
a. DXA scan technique
b. Reporting (double reporting)
c. Reporting (clinical review)
d. Scanner QA review
e. Other- please state
f. unknown

3) What IR(ME)R audits do you routinely undertake? Please tick all that apply
a. Patient pregnancy
b. DXA dose audit
c. Referrer entitlement
d. Scan justification
e. Other- please state
f. unknown

4) What clinical protocols do you have in place? Please tick all that apply
a. Scan site
b. Scan mode
c. Reference data selection
d. Patient positioning
e. Scan analysis
f. Interpretation- T&Z-scores
g. Reporting
h. Other- please state
i. Unknown

5) Which of the following are routinely included in the DXA report issued to the PRIMARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment
ii. Patient ID and demographics
iii. Reason for referral
iv. Reporter’s ID
b. BMD results for each measurement site
i. T score (after peak bone mass)
ii. Z score
iii. Rate of change for serial measurements
c. Comment on reliability of measurements
i. BMD results
ii. Documentation of excluded measurements eg vertebrae
iii. Statistical significance of rate of change
iv. Clinical significance of rate of change
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg low/moderate/high)
i. Management advice
i. Reference to national guideline (NICE/NOGG/ROS)
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional investigation
ii. Timing of future scan

6) Which of the following are routinely included in the DXA report issued to the SECONDARY CARE referrer? Please tick all that apply
a. Admin. details
i. Date of assessment
ii. Patient ID and demographics
iii. Reason for referral
iv. Reporter’s ID
b. BMD results for each measurement site
i. T score (after peak bone mass)
ii. Z score
iii. Rate of change for serial measurements
c. Comment on reliability of measurements
i. BMD results
ii. Documentation of excluded measurements eg vertebrae
iii. Statistical significance of rate of change
iv. Clinical significance of rate of change
d. WHO diagnostic category (for adults after peak bone mass)
e. Results of additional investigations performed at DXA appointment
i. VFA
ii. X-ray or other imaging
iii. Laboratory tests
f. Summary of clinical risk factors for fracture
g. Summary of fracture history
h. Clinical interpretation to quantify absolute fracture risk
i. FRAX+BMD
ii. FRAX + TBS
iii. FRAX+BMD plus comment on additional adjustment
iv. Statement on level of risk based on clinical judgement (eg low/moderate/high)
i. Management advice
i. Reference to national guideline
ii. Reference to local management guideline
iii. Individualised advice
j. Recommendations on:
i. Need for onward referral eg falls assessment or additional investigation
ii. Timing of future scan
k. The secondary care report is the same as the primary care report