3727 Addressing inequities in dual-energy x-ray absorptiometry (DXA) access: a multi-dimensional quality improvement approach

Abstract

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, 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.

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