The versatility of BMD screening makes a difference in Phoenix

For a radiology practice that performs nearly 250 bone mineral density studies a week, consistent performance is essential. Just ask Tammy Sanchez, RT(R),CDT quality assurance manager and mammography/ bone densitometry coordinator at Valley Radiologists in Phoenix, Arizona. Overseeing ten offices in metro and suburban Phoenix, Tammy saw the benefit of a single-vendor approach to DXA imaging technology early on.

In 2004, Valley's merger with Scottsdale Medical Imaging to form Southwest Diagnostic Imaging necessitated an evaluation of the practice's DXA equipment. "We chose to go with one vendor," Tammy explained, "because our goal is for our results and information to be as accurate as possible. When you're trending a patient you want to stay with one manufacturer."

When you're trending a patient you want to stay with one manufacturer

"We do about 13,000 BMD studies a year," Tammy said. "With such a vigorous workload, trending patient information is a critical aspect of the work being done at Valley Radiologists. And we do more than just osteoporosis studies. We're very fortunate to have some really attentive referring physician groups, like pediatric groups." In fact, approximately 8-10% of the DXA patients at Valley's Glendale office are children between the ages of 10 and 16. Young patients are most often screened for osteogenesis imperfecta, a group of genetic syndromes more commonly known as brittle bone disease. "For most of these cases, we do a pediatric whole body study and give a bone mineral content score every two years."

Valley also participants in clinical trials. A recent blinded study measured the effect of particular treatments on young children with pituitary cancer, using whole body studies and body mass index testing.

Valley is currently involved in lipoprotein studies of HIV patients, pediatric patients, and adults receiving chemotherapy. "Until this year the company had asked me to be the only technologist that handles the DXA clinical trials because they wanted consistency," Tammy points out, "but I got to a point where I needed to teach others how to do them. I think it benefits the technologists because they become more attentive to precision and accuracy."

Tammy believes the Hologic Discovery W (whole body) system gives Valley Radiologists the precision they require for participation in clinical trials as well as in their daily workload. "The Discovery system is very user-friendly," she noted. "There are a lot of automated processes and you want to rely on those as much as possible, so that it's consistent every time the patient comes in. If you have your positioning correct, your automatic analysis should work very well."

Discovery streamlines reporting

In a practice of Valley's size, optimized workflow is a must. "Now that we have gone through the connectivity process, we don't have to enter patient data by hand anymore. We just click on the worklist, click on the patient's name, and Discovery populates all of the demographics and the biography of the patient," Tammy said.

She is particularly impressed with the system's automatic data import feature, which compares prior scans to current ones. "Before we had to do all of the conversion math by hand. We used to have to figure out the area and the bone mineral content to come up with the bone mineral density and then convert it (there's a conversion factor for each manufacturer) and then we'd use that conversion formula and do our comparison. It was a lengthy math process that of course has room for human error, and now it's all done electronically for us. That's awesome."

Recently, Valley Radiologists began to add Hologic Discovery A bone densitometers to their practice. The Discovery A has the same patient spine, hip, and whole body scanning capabilities as the Discovery W model, but Discovery A also includes a rotating C-arm that allows a true 90-degree lateral scan of the thoracic and lumbar spine for vertebral fracture assessment. With non-rotating systems, the patient has to roll on their side, which may not always be easy or comfortable for a geriatric patient. With the Discovery A's exclusive rotating capability, the tube head rotates instead of the patient.

Valley's Goodyear and Northwest Glendale offices, which are in the west part of metropolitan Phoenix, serve a largely geriatric population - approximately 70 percent of the patients in these areas are over 55. It is more relaxing for geriatric patients knowing they can remain on their back with no discomfort and yet get better vertebral fracture information. "Being able to do supine lateral imaging without moving the patient is a real feather in our cap," Tammy explained.

An added plus of the vertebral fracture assessment on the Hologic Discovery A is the ability to visualize abdominal aortic calcifications, which are strongly associated with cardiovascular disease. AAC is a particularly valuable measurement since it correlates with traditional clinical risk factors such as cholesterol, blood pressure, diabetes, and age to the prediction of heart attack risk.

An added plus of the vertebral fracture assessment on the Hologic Discovery is the ability to visualize aortic calcifications, which are strongly associated with cardiovascular disease

Tammy has seen the Discovery A system increase patient throughput without sacrificing precision.

Hologic service is another plus

With a steady stream of patients putting Valley Radiologists DXA equipment to the test, the availability of vendor on-demand equipment service is particularly important. "It would take us 4 or 5 days to get our previous vendor to our sites to check out equipment. That was difficult for us because we weren't servicing our customers and our revenue was reduced.. Hologic has an 800 service line and all of our technologists know that if they get in trouble they just call Hologic. Often times the 800 service line resolves the problem while on the phone with the technologist and if they cannot, a service engineer contacts us the same day. The engineer determines the parts needed for repair, places the order and meets the parts on site for the service call within 48 hours - they've always been available when we've needed them."

Valley Radiologists has chosen Hologic for both DXA and mammography

Tammy's single-vendor approach also extends to the mammography side of the practice. In December of 2006 Valley Radiologists began converting their analog equipment to Hologic Selenia digital mammography systems. "We've actually purchased five Selenias," she explained. Tammy notes that the cohesiveness of installation and training for both DXA and mammography is great. "We recently scheduled applications for both DXA and mammography in the same week. Everything just came together and it went perfectly."

Valley likes to offer their patients the convenience of having their mammograms and DXA studies during the same office visit. It's not possible in every case because of scheduling conflicts, but it's offered when appointments are available. "I do mammography and DXA whenever I work at a site," Tammy pointed out. "When a patient comes in for her DXA and says that she's scheduled for a mammogram but couldn't get in for another two months, I'll offer to do her mammogram right then so she won't have to make a trip back." That's exactly the kind of flexibility and customer service that have made Valley Radiologists a success.