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Four Essential Elements

Essential Elements Clarifications and Compliance – Facility Accreditation Glossary (.pdf)

1. DXA Personnel:

   DXA Facility Primary Contact

   • The Primary Contact is the person who is responsible for all correspondence regarding the application, payment of fees and submission of all documents for the application. This could be the facility director or site administrator.
   • The Primary Contact will list the required contact information for the application: Facility Name, Primary Contact name, mailing address, phone number, fax number, email address as well as (optional) website.
   • Each facility is required to provide new contact information if changes are made during the period of accreditation as this is the person with whom all communication will occur.

   Designated Primary Interpreter (DPI)

   • Each facility shall point out a Designated Primary Interpreter (DPI) that is responsible for upholding and defending following established uniform approaches to DXA nomenclature, data collection, acquisition, analysis, and reporting within the facility and all satellites associated with the application. The DPI oversees the training of the other Interpreters (whether certified or not) and the quality of scans and reports from all locations associated with the application. The Designated Primary Interpreter's submissions carry the most weight with assessors when the application is graded as a whole.

   Designated Primary Technologist (DPT)

   • Each facility shall point out a Designated Primary Technologist (DPT) that is responsible for upholding and defending following established uniform approaches to quality assurance/quality control procedures, facility standard operating procedures, data protection and storage protocol, acquisition, and analysis within the facility and all satellites associated with the application. The DPT oversees the training of the other technologists (whether certified or not) and the quality of scans from all locations associated with the application. The Designated Primary Technologist's submissions carry the most weight with assessors when the application is graded as a whole.

   Primary DXA Interpreter

   • The Primary Interpreter is Certified Clinical Densitometrist (CCD) or has another certification that is equivalent.
   • The Primary Interpreter is a physician, nurse practitioner, physician assistant, fellow, PhD. or other equivalent degree.
   • The Primary Interpreter upholds and defends following established uniform approaches to quality assurance/quality control procedures, facility standard operating procedures, data collection, protection and storage protocol, acquisition, analysis, DXA nomenclature and reporting within the facility.
   • There may be more than one Primary Interpreter per facility.
   • The Primary Interpreter will list all credentials, training, certifications and continuing education related to metabolic bone disease/ DXA technology/ osteoporosis. In addition, the Primary Interpreter will list all DXA experience.

   Non-Primary DXA Interpreter

   • The Non-Primary DXA Interpreter follows established uniform approaches to DXA nomenclature, data collection, acquisition, analysis, and reporting within the facility.
   • The Non-Primary DXA Interpreter is a physician, nurse practitioner, physician assistant, fellow or PhD. or other equivalent degree.
   • The Non-Primary DXA Interpreter will list all credentials, training, certifications and continuing education related to metabolic bone disease/ DXA technology/ osteoporosis. In addition, the Interpreter will list all DXA experience.

   Primary DXA Technologist

   • The Primary Technologist is either a Certified Densitometry Technologist (CDT), a Certified Bone Densitometry Technologist (CBDT) or has passed American Registry of Radiologic Technologist's Bone Densitometry post-primary certification (ARRT) (R) (BD) within the last three years. If more than three years since passing ARRT (BD) exam, then Technologist must also show 24 hours of continuing education within the last three years pertaining to metabolic bone disease/ DXA technology/ osteoporosis.
   • The Primary Technologist is a Radiologic Technologist, Registered Nurse, or other healthcare professional that performs bone density scans.
   • The Primary Technologist upholds and defends following established uniform approaches to quality assurance/quality control procedures, facility standard operating procedures, data protection and storage protocol, acquisition, and analysis within the facility.
   • There may be more than one Primary Technologist per facility.
   • The Primary Technologist will list all credentials, training, certifications and continuing education related to metabolic bone disease/ DXA technology/ osteoporosis. In addition, the Primary Technologist will list all DXA experience and individual precision and LSC values based on 95% confidence level.

   Non- Primary Technologist

   • The Non-Primary DXA Technologist is a Radiologic Technologist, Registered Nurse, or other healthcare professional that performs bone density scans.
   • The Non-Primary DXA Technologist follows established uniform approaches to quality assurance/quality control procedures, facility standard operating procedures, data protection and storage protocol, acquisition, and analysis within the facility.
   • The Non-Primary DXA Technologist will list all credentials, training, certifications and continuing education related to metabolic bone disease/ DXA technology/ osteoporosis. In addition, the Technologist will list all DXA experience and individual precision and LSC values based on 95% confidence level.



2. Quality Assurance (QA) and Quality Control (QC)

   • QA/QC Protocols, Procedures and Timetables
     • Each facility will provide answers to worksheet questions regarding obtaining and recording patient history information, in-vivo precision assessment procedures and baseline and serial scanning procedures to demonstrate compliance with established positions and best practices.
     • Each facility will submit the most recent in-vivo precision assessments performed at the facility including Least Significant Change values for L1-L4 and total proximal femur that are currently used, based on a 95% confidence level, to demonstrate compliance with established positions and best practices. This can be in the form of ISCD Precision Calculator pages or other spreadsheet.
     • For each DXA scanner, the facility will provide answers to worksheet questions regarding Spine Phantom inventory for each DXA scanner, rules and processes applied to Spine phantom results to determine machine failure, and other QA/QC parameters monitored, if any.



3. DXA Scan Acquisition and Analysis

   • DXA Scanning Protocols and Procedures
     • All DXA Technologists (Primary and Nom-Primary) will provide a list of precision (%CV and g/cm2) and LSC (% and g/cm2) values based on 95% confidence level.
     • All DXA Technologists (Primary and Nom-Primary) will submit one baseline and one follow-up Spine scan for the same patient for review and grading.
     • All DXA Technologists (Primary and Nom-Primary) will submit one baseline and one follow-up Femur Scan for the same patient for review and grading.
     • All DXA Technologists (Primary and Nom-Primary) will submit one Forearm scan for review and grading.
     • All DXA scans must be submitted with clear images. BMD, BMC, area, scan mode, and all regions of interest, including sub-regions must be visible. Scans or reports must not include patient's real name, date of birth or social security number. All technologists must submit their best work. If serial scans from the same patient are not available, scans from the tech's precision study can be submitted.



4. DXA Scan Interpretation and Reporting

   • Components of the Interpretive Report according to ISCD Official Positions
     • All DXA Interpreters (Primary and Non-Primary) will submit one baseline and one follow-up DXA report (from the same patient) showing comparison to the baseline for review and grading. The DXA scans referenced in each submitted report must also be submitted with the report. (These are separate from technologists scans.) All images must be clear. BMD, BMC, area, scan mode, and all regions of interest, including sub-regions must be visible. Scans or reports must not include patient's real name, date of birth or social security number.

Essential Elements Clarifications and Compliance – Facility Accreditation Glossary (.pdf)

Questions:

Contact: Kim Swircenski, A.S., RT(R)(BD)(CBDT)
ISCD Facility Accreditation Manager

E-mail:facility@iscd.org
Phone:860.259.1000 ext. 107

Fax:860.259.1030

Page Last Updated: 04/20/2012

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