Purpose or Case Report: To describe and discuss some of the challenges of performing DEXA scans on pediatric patients including positioning, technical obstacles, reference data and post-processing and describing how to overcome some of these challenges.
1. Positioning: Many patients with syndromes, have scoliosis, para or quadriplegia, or contractures that make placing the patient on the table difficult. In these patients, imaging has to be adapted to the patients’ abilities and some components may need to be eliminated. With cerebral palsy and muscular dystrophy for example, the whole body and AP spine might have to be deferred and only a hip and forearm obtained.
2. Technical obstacles: There are many technical obstacles that can present challenges when performing DEXA scans on pediatric patients. Patients who have prostheses or metal rods present technical obstacles. There is no way to remove the metal artifacts in a whole body scan on these patients, so a hip or forearm might be the most accurate way to obtain the patient’s bone density due to this technical factor.
3. Reference Data: The reference data for pediatrics is limited in national data bases. For example, a total Z-score will not be factored for children under the age of 5 because there is not enough information in the national database for comparison. There is also not enough information on children of certain ethnicities. This presents a problem when diagnosing and treating children with abnormal bone density.
4. Post-processing could be different for each user. It can also be different for machines manufactured by different companies. For example, a machine made by Hologic might produce different numbers than a machine made by General Electric. Also, if the user does not place the post-processing tools the exact same way the prior user did, the results can vary.
Overcoming some of these challenges has presented opportunities to grow. Sedation is used for children who may not be able to be perfectly still for a Dexa and positioning tools help on some of the more challenging patients. Learning how to work around prostheses and working with the ordering physicians and radiologists with the limited amount of reference data are a few ways of growing from these challenges. Placement of post-processing tools are the key to providing key information in comparing Dexa scans for patients who have them regularly for evaluations. Staff Education is the largest challenge to overcome.
Methods & Materials:
Results:
Conclusions: