ISCD COVID – 19 DXA Guidance

May 13, 2020

To the ISCD Community:

As we continue to follow the COVID-19 Pandemic and its impact on our members, we are providing additional information and resources to build upon our initial statement regarding DXA during COVID-19 (found below), 

ISCD recognizes that many densitometers worldwide have been idled by the COVID-19 pandemic, and that returning to operations may elicit anxiety in staff and patients about safety.

To help preserve optimal machine function during extended lapses in use, manufacturer-specific procedures have been recommended to ISCD and are summarized below:

Hologic:  Best practice is to run a daily quality assurance every two weeks.  If that’s not possible, perform quality assurance two times every 30 days.  Try to avoid leaving the scanner idle for more than two months.  (SkeletalHealth.Support@Hologic.com)

GE Healthcare:  If a bone densitometry system has been idle for more than one month, recommend performing a warm-up seasoning of the X-Ray tube prior to resuming clinical use.  Please contact GE Healthcare for instructions: https://www.gehealthcare.com/corporate/covid-19

Norland: 

Run a “Daily Calibration” at least once every two weeks if possible. This will help prevent possible arcing issues. If you are not able to achieve this due to lack of access to building, stay at home orders, etc., suggest running an initial calibration upon return. Instructions for running this initial calibration are found in our operator’s guide which every customer should have access to and if they need additional assistance, they can call technical support line at 1-888-741-0413.

In addition to the above manufacturer- specific procedures, ISCD recommends the following resources to assist in reassuring staff and patients regarding safety of densitometry in the era of COVID-19. We understand that local, state and other jurisdictional guidance and rules may supersede:

US Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-covid-19-client-interaction.html

American College of Radiology: https://www.acr.org/Clinical-Resources/COVID-19-Radiology-Resources

https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Resumption-of-Non-Urgent-Radiology-Care-during-the-COVID-19-Pandemic

American Society of Radiologic Technologists: https://www.asrt.org/covid19

Radiological Society of North America: https://www.rsna.org/-/media/Files/RSNA/covid-19/RSNA-COVID-19-Surge-Preparedness.pdf

Best wishes,
Dato’ Dr. Joon-Kiong Lee, MBBS, FRCS, MS ORTH, AM, CCD   
ISCD President 2020-2021
For the ISCD Executive Committee

ISCD Initial COVID-19 Statement March 30, 2020

March 30, 2020

To the ISCD Community:

We recognize the magnitude and health care disruption of the worldwide COVID-19 pandemic and want to provide interim guidance on bone densitometry testing during a worldwide crisis and USA National Emergency.

During the USA emergency, we do not consider any form of DXA (including VFA and FFI) as essential to the health of the individual. This would apply to other regions as well.

We also recognize that your jurisdictions’ advice may not align with and in fact may supersede this ISCD guidance.

This advice was formulated with the input and review of the ISCD Executive Committee:

Delaying or deferring DXA for diagnosis or monitoring is appropriate for 3-6 months because:

  1. For most patients there will be little clinically meaningful change in BMD over the period.
  2. For those on treatment with established acceptable response, there is a very low likelihood that the response will change.
  3. For those transitioning from anabolic therapy to anti-resorptive therapy, it is far more important to consolidate gains achieved by switching without DXA results first.
  4. For those newly on therapy set up for first monitoring DXA, there will also be little meaningful change over the interval.
  5. DXA services are increasingly performed in facilities, and many of those facilities already are or will be shifted to emergency and/or crisis management, where “elective” radiology will be severely limited if not curtailed. Over this anticipated short duration of 3-6 months, restricting this service does not pose a substantial threat to patients needing BMD testing.

We want to be a small part of the solution to the present worldwide pandemic and offer reassurance for patients and providers faced with many difficult decisions.
Please stay well, follow recommendations to stay safe and keep others safe. We will get through this together.

Best wishes,

Christopher R. Shuhart MD, MHA, CCD
ISCD President 2019-2020
For the ISCD Executive Committee

Last modified: May 15, 2020