[Intl_DxMedPhys] QCT Bone Density vs DXA for routine screening

[delmer at mpcphysics.com]

I've had a client ask about performing routine bone density screening using
QCT rather than DXA.  They are asking because they are a small rural
hospital and their DXA scanner needs to be replaced.  They would prefer to
add the software to their relatively new CT scanner than to replace the DXA
scanner.

 

I did a little research and learned the following:

 

ACR Appropriateness Criteria

https://urldefense.com/v3/__https://acsearch.acr.org/docs/69358/narrative/__;!!KGKeukY!xv65QrCa9w7CzPTZSd84ns-hnLWcQd64LsZRL58bX-Fczvk4UHxsN4HtuVvPDO6R-TLmk3s-eCS5Fi-whOwOZF29bIRQnt94LH88zWmj$ 

 

Quantifying the Opportunity and Economic Value of Bone Density Screening
Using Opportunistic CT: A Medicare Database Analysis

Gyftopoulos, Soterios et al. Journal of the American College of Radiology,
Volume 22, Issue 3, 349 - 357

https://urldefense.com/v3/__https://www.jacr.org/article/S1546-1440(24)00837-8/fulltext__;!!KGKeukY!xv65QrCa9w7CzPTZSd84ns-hnLWcQd64LsZRL58bX-Fczvk4UHxsN4HtuVvPDO6R-TLmk3s-eCS5Fi-whOwOZF29bIRQnt94LLRhgcnq$ 

 

Most of the relevant literature I've read refers to bone density screening
using "opportunistic CT".  I've not seen any literature suggesting routine
bone density screening with QCT in lieu of DXA.  Although the ACR
Appropriateness Criteria reflects that it "may be appropriate" in 5 of the 6
variants described, the text seems to strongly support it only for Variant 6
(Initial imaging in males and females greater than or equal to 50 years of
age. Suspected osteoporosis. Advanced degenerative changes of the spine with
or without scoliosis, or other conditions that may spuriously elevate BMD). 

 

According to the ACR Appropriateness Criteria, the radiation exposure from
the QCT is 10-100 times greater than the exposure from the DXA (<0.1mSv for
DXA; 1-10 mSv for QCT).

 

I'm told that there is a CPT code for it (77078). 

 

I'm interested in what more you know about this.

 

Are other facilities using QCT for routine bone density screening?

 

Diane M. Elmer, M.S., DABR, CHP

Medical Physicist

Medical Physics Consultants, Inc.

Cell:  (217) 553-3049



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