DXA Facilities Audit
Dear North West Anglia 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
Dear Craig/Steven
Reference Number FOI 2023 - 122
Thank you for your request for information from North West Anglia NHS Foundation Trust.
We anticipate being able to provide a response within the timescales allowed under the Act.
In the meantime if you have any questions regarding this request please contact us directly quoting the reference number above.
North West Anglia NHS Foundation Trust comprises of Peterborough City Hospital, Hinchingbrooke Hospital and Stamford & Rutland Hospital. The Trust also provides community clinics at Princess of Wales Hospital in Ely, Doddington Hospital and North Cambs Hospital in Wisbech. Further information is available via our website www.nwangliaft.nhs.uk.
Any future Freedom of Information requests should be addressed to North West Anglia NHS Foundation Trust using the email address below.
Kind Regards
The Freedom of Information Team
Hinchingbrooke Hospital
North West Anglia NHS Foundation Trust
[North West Anglia NHS Foundation Trust request email]
Ref: FOI/2023/122
Dear Craig
Thank you for your recent enquiry under the Freedom of Information Act.
Please find your response detailed below.
Requesters Question and Trust Response:
Infrastructure:
1) Do you outsource your DXA scans? No
2) In January 2023 how many DXA scanning machines did you have at
your trust/board for clinical use?
a. 2
b. 0
c. 0
3) What is the average weekly capacity for clinical scans? (N. of
scans per week) Average of 119.5 scans per week performed
4) What was your average DNA rate over the last 3 months? (n.
DNA/total n. scans booked) – 5%
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? Not recorded
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? Not recorded
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 Diagnostic Imaging
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) National Programme of Bone
Densitometry
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) – Rhuematology
if needed
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) ROS
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) Rhuematology
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) 0
Quality:
1) Is your service accredited as part of a national programme?
a. ISAS - partially
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
Please note that this response has been provided within the 20 working
day timeframe as stipulated in the Act.
North West Anglia NHS Foundation Trust comprises of Peterborough City
Hospital, Hinchingbrooke Hospital and Stamford & Rutland Hospital. The
Trust also provides community clinics at Princess of Wales Hospital in
Ely, Doddington Hospital and North Cambs Hospital in Wisbech. Further
information is available via our website [1]www.nwangliaft.nhs.uk.
If you disagree with our decision or are dissatisfied with how we have
dealt with your request in the first instance you may contact me on the
following email address [2][North West Anglia NHS Foundation Trust request email] to request an
internal review.
Should you remain dissatisfied with the outcome you have a right under s50
of the Freedom of Information Act to appeal against the decision by
contacting:
Information Commissioner
Wycliffe House
Water Lane
Wilmslow
SK9 5AF
Phone: 0303 123 1113
Email: [3][email address]
Yours sincerely
FOI Team
Hinchingbrooke Hospital
North West Anglia NHS Foundation Trust
[4][North West Anglia NHS Foundation Trust request email]
Dear FOI team (NORTH WEST ANGLIA NHS FOUNDATION TRUST),
Many thanks for your response to our FOI request. Unfortunately, the system we use to process the FOI request has removed the formatting from your response email and it is not clear where you have highlighted the answers.
Please could you re-send your response as a word document or PDF? This can be simple copy and paste of your email response for ease.
Many thanks
Nikos Methenitis
Policy and Public Affairs Officer
Royal Osteoporosis Society
Dear Nikos
Thank you for your email. Please find attached a PDF for our response.
Please let me know if we can be of any further assistance.
Kind regards
Colette
FOI Team
North West Anglia NHS Foundation Trust
Email: [North West Anglia NHS Foundation Trust request email]
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