Abstract
Introduction:
Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis and guiding osteoporosis treatment, particularly when used alongside fracture risk assessment tools such as FRAX. Limited access to DXA scans in some centres, highlighting the need to prioritise their use effectively. The project is aimed to improve DXA access and prompt reporting to meet Fracture Liaison Service Database (FLS-DB) national standards.
Methods: This multi-dimensional improvement project began in 2022 using the Model for Improvement. Process mapping identified inefficiencies, with ownership secured through Radiology Directorate and cross-divisional engagement involving Clinical Leads from Rheumatology and Care of the Elderly. A small multidisciplinary working group was formed to drive the change. Progress was monitored via FLS-DB Key Performance Indicator 5 (KPI 5): percentage of patients receiving a DXA within 90 days of fracture and DXA waiting list.
Results: Baseline results in 2021: 875 fragility fracture patients identified; 29.2% (255) scanned within 90 days, average DXA waiting list 1028/month
Initiatives between 2022 and 2024 included training of radiographer, vetting of repeat DXA scan request (eg repeat DXA not needed for patients on anabolics, no fracture whilst on Denosumab or Zoledronate) and expanding scanning from 3 to 5 days/week; dedicated DXA reporting training and non-reporting agreement for FLS patients.
Impact of FLS expansion on DXA scan waiting:
- 2022: 1648 fracture patients identified; 16.8% (276) scanned; waiting list rose to 1541/month.
- 2023: 2179 fracture patients identified; 17.4% (379) scanned; waiting list increased to 1980/month.
Impact of quality initiatives:
- 2024: 2621 patients identified; 25.7% (673) scanned (163% increase from 2021); DXA waiting list dropped to an average 849/month.
- 2025: DXA waiting list reduced further to average 786/month.
Conclusion: The quality improvement project initiated in 2022, took three years to streamline our referral pathways. Two radiology staff training and operating five-day DXA scanning helped reduce both the DXA scan waiting list and clinician reporting time. The current service has adopted good practices to improve DXA scanning provision to match the demand of increased fracture case identification. However, further improvement is needed.
Comments
This is a very important and…
This is a very important and timely topic. Addressing inequities in DXA access is essential for ensuring early and accurate diagnosis of osteoporosis across all patient groups. A multi-dimensional quality improvement approach is an excellent strategy, as it allows for tackling barriers related to geography, resources, and awareness simultaneously. By improving accessibility and standardizing referral pathways, such initiatives can lead to more equitable care and better long-term fracture prevention outcomes.
Focused multidimensional quality improvement project
the positive impact of dedicated resource allocation (radiology staff training and expanded scanning days) on a critical patient pathway. Achieving a significant reduction in the DXA waiting list while simultaneously increasing the percentage of patients scanned within the 90-day target directly addresses the quality gap. The shift from 276 to 673 scans completed within 90 days is a powerful outcome.
This improvement should be highly commended for making DXA access more equitable and timely for high-risk Fracture Liaison Service (FLS) patients
Clearly hard work
This abstract clearly demonstrates the positive impact of the quality improvement project. The strategy, including streamlining referral pathways and increasing DXA capacity, significantly reduced the DXA waiting list by over 50% since the project began, enhancing timely patient care.
This poster highlights a…
This poster highlights a thoughtful, multi-dimensional strategy to reduce inequities in DXA access, combining data-driven insights and collaborative practice to improve service reach, consistency, and patient outcomes for sustained equity.
The conclusion is very compelling.
I'm impressed by the depth of this project and analysis. .
The level of expertise is impressive.