Facility Accreditation Program FAQ

What is ISCD Facility Accreditation?

  • A five-year accreditation awarded to DXA facilities (not individuals) demonstrating quality in their DXA services, based on the Essential Elements of Accreditation.
  • The accreditation process is a practice-based assessment of facilities that perform and report bone densitometry measurements in clinical settings.
  • Accreditation is not to be confused with certification of individuals as ISCD CCD, CBDT, or CDT(International).


Why should my facility apply for ISCD Accreditation?

  • Protect and reassure the public that your clinicians and technologists meet standards for quality patient assessment based on current scientific knowledge.
  • Improve accuracy and precision by adhering to a uniform approach to nomenclature, data collection, acquisition, analysis and reporting.
  • Verify to payers that quality standards are in place in your facility.
  • Promote your DXA services:  Your facility’s name, contact information and website will be listed on the ISCD website. Patients and professionals can search for an ISCD Accredited Facility in their area.


How does my facility apply for ISCD Facility Accreditation?

  • All required forms can be found on the Accreditation application page of ourwebsite or you can contact the Facility Accreditation Manager, Phone: 860.259.1000 ext 105; Fax: 860.259.1030; E-mail: facility@iscd.org


Who is eligible to apply for ISCD Facility Accreditation?

  • Currently, all active DXA facilities in the United States, located in hospitals, medical clinics, private medical offices, research facilities (capable of generating DXA reports), mobile DXA centers, and free-standing imaging centers.
  • Facilities perform DXA of the spine, hip, and forearm in human subjects for diagnosis, fracture risk assessment and monitoring.

Do all of our DXA facility’s technologist’s and interpreter’s need to be ISCD certified?

  • It is recommended but not required. DXA facilities must have at least one primary interpreter and at least one primary technologist certified by ISCD or an acceptable equivalent. If the Facility has more than one certified technologist or Clinician/Interpreter, the facility will designate one primary technologist and one primary clinician/interpreter for the application.


What is the purpose of a Designated Primary Technologist and Designated Primary Interpreter?

  • The Designated Primary Technologist’s submissions and Designated Primary Interpreter’s submissions carry the most weight with assessors when the application is graded as a whole. Each facility shall designate a Designated Primary Interpreter (DPI) that is responsible for upholding and 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.


Why does our facility need to submit DXA scans and reports if all of the technologists and interpreters are ISCD certified?

  • Certification is proof of knowledge, but DXA scan and report submissions demonstrate that a facility is using that knowledge in practice.


Why should ISCD Accredited facilities have the ability to scan the forearm?

  • It is not uncommon to have situations calling for the use of forearm DXA. According to theISCD Official PositionsForearm BMD should be measured under the following circumstances:
  • Hip and/or spine cannot be measured or interpreted.
  • Hyperparathyroidism
  • Very obese patients (over the weight limit for DXA table)


What is a Spine Phantom scan?

  • A DXA quality control test in which an artificial spine of known density is scanned using the same acquisition parameters as when scanning a patient for the purpose of monitoring stability of the DXA machine over time.


Why should our facility perform Spine Phantom Scans if not recommended by the DXA manufacturer?

  • Excerpt from theISCD Official Positionson Phantom Scanning and Calibration:
  • The Quality Control (QC) program at a DXA facility should include adherence to manufacturer’s guidelines for system maintenance. In addition, if not recommended in the manufacturer protocol, the following QC procedures are advised: Perform periodic (at least once per week) phantom scans for any DXA system as an independent assessment of system calibration.


What is a “short-term in-vivo precision assessment”?

  • A procedure in which a group of individuals is scanned more than once within a short period of time (usually the same day as long as complete re positioning occurs between each scan).
  • 15 individuals are scanned 3 times each OR
  • 30 individuals are scanned 2 times each
  • For the purpose of testing a technologist’s ability to reproduce precise positioning and analysis. When properly performed, bone density measurements are one of the most precise quantitative measurements in use in clinical medicine today.
  • To obtain the Least Significant Change (LSC) values used by your DXA interpreters when reporting a comparison between a patient’s baseline and follow-up scans.
  • Also see Precision Assessment FAQs


What is an LSC?

  • Simply, the amount that a patient’s measured BMD must change to demonstrate with statistical confidence that a real change has occurred.


Why do all of our facility’s technologist’s need to perform a short-term in-vivo precision assessment?

  • Each DXA facility should determine its precision error and calculate the LSC
  • Every technologist should perform and in-vivo precision assessment


When should precision assessment be performed?

  • Excerpt from theISCD Official Positionson Precision Assessment:
  • Each technologist should do one complete precision assessment after basic scanning skills have been learned
  • A repeat precision assessment should be done if a new DXA system is installed
  • A repeat precision assessment should be done if a technologist’s skill level has changed


What is the ISCD Precision Calculator?

  • A tool located on the ISCD website that allows the user to manually type in BMD values measured during in-vivo precision assessment. Automatic calculations are made for Precision Error (PE) and LSC values. ISCD offers the precision calculator as both aweb based and downloadable toolto registered users for free.

How do the Facility Accreditation assessors determine my DXA interpretive reports are acceptable to ISCD?

  • Assessors use worksheets for grading DXA reports. All evaluation criteria may be found in the ISCD Official Positions.


Tips for submitting DXA interpretive reports for the ISCD Facility Accreditation

  • Reports must be in agreement with the2013 ISCD Official Positions. Be sure to check your reports for compliance with the Positions before submitting your application.
  • Identify all skeletal sites and ROIs; HOWEVER, asingle diagnosis should be made based on the lowest site (lumbar spine, femur neck, total femur, one-third radius).
  • Give a statement of technical quality of the scan including potential limitation and rationale for any excluded ROIs.
  • Appropriate use of T-scores vs. Z-scores according to the ISCD Official Positions (based on patient age and menopausal status).
  • When using T-scores, use proper category based on criteria in the World Health Organization Technical Report Series. Geneve: WHO, 1994
  • The presence of a fragility fracture can indicate a diagnosis of Osteoporosis regardless of T-score.
  • When reporting on serial scans, indicate the significance of any change in g/cm2 and percentage. LSC values and dates of comparison scans should be included in all follow-up reports.
  • See report content sections of the ISCD Official Positions:Baseline DXA Report Minimum Requirements, Follow-Up DXA Report, and DXA Report: Items That Should Not be Included.
  • See DXA Interpretive Report Template.
  • If FRAX is used, it must be in compliance with the2010 Positions of the ISCD/IOF on the Interpretation and Use of FRAX in Clinical Practice and the NOF/ISCD FRAX Implementation Guide.


Last modified: February 28, 2017