Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit

Howlett, David; Drinkwater, K.; Mahmood, Nadia; Illes, Jozsef; Griffin, Jill; Javaid, K

doi:10.1007/s00330-020-06845-2

Cited by 29 publications

(35 citation statements)

References 42 publications

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“…Fractures, particularly those of the hip and spine, are devastating, with up to 30% mortality at 1 year following hip fracture and significant ongoing morbidity. Vertebral fractures are highly predictive of further fracture but reporting of these is poor in the UK [ 66 ] and there are a number of reasons why this may be even lower in an oncology setting [ 67 ]. The risk of poor bone health and fracture is increasingly recognised across a number of malignancies; for example, a recent large Danish registry study showed increased risk of fragility fracture in adults with haematological malignancy, with the largest risk in the first 2–4 years following initiation of treatment [ 68 ].…”

Section: Interface With Other Specialities (Eg Endocrinology and DImentioning

confidence: 99%

Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as ‘the prevention and management of the adverse effects of cancer and its treatment’. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.

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Section: Interface With Other Specialities (Eg Endocrinology and DImentioning

confidence: 99%

Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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“…Two prior studies from Belfast showed a prevalence of VF ranging from 2.7% in a fracture liaison service setting ranging up to 40.7% a cross-sectional study of a group of Northern Ireland men with low-trauma forearm fractures [21,22]. More recently, in a UK national audit of vertebral fragility fractures in 6357 patients, a lack of compliance to ROS standards was noted with use of recommended terminology being achieved in 60.3%, a comment on fracture severity at 26.2% and recommendation for referral/further assessment in only 2.6% [1,23]. Our baseline audit identified a prevalence of incidental moderate to severe VF in 15.6% of unselected consecutive series of 154 patients attending for computed tomography for investigation by a range of specialist services.…”

Section: Discussionmentioning

confidence: 99%

“…A range of terminology was used to describe VFs, and in 46% of cases, the term fracture was not used. Following educational initiatives and roll out of the QIP, the term fracture was used in all cases of this series, which compares favourably to other UK settings [23]. It is difficult however to estimate the true prevalence of fractures within our wider Health Trust as these cases represent a small proportion of the total number of cases referred for imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Osteoporosis management following VF remains inadequate when secondary fracture prevention programmes are not implemented [23]. Whereas epidemiological data in the USA show that VFs account for 27% of annual fragility fractures, UK data suggest that radiologists miss VFs in more than 50% of cases [23]. The important role of fracture liaison services, which are cost effective for fracture prevention, was highlighted in a recent US study [24].…”

Section: Discussionmentioning

confidence: 99%

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Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

Toal¹,

McLoughlin²,

Pierce³

et al. 2020

Arch Osteoporos

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Summary We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. Purpose Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). Methods We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. Results Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology ‘fracture’ increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. Conclusions Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.

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“…Bearing in mind that the majority of the causal vertebral fragility fractures (VFFs) already occurs in osteopenic individuals [3] emphasizes the importance of early detecting patients at risk. A UK audit, however, s h o w e d t h a t i n c i d e n t a l V F F s a r e s u b s t a n t i a l l y underdiagnosed in non-dedicated CT exams due to deficient reporting [4]. Here, even basic tools (e.g., routine sagittal reformations, stringent terminology) could improve clinico-radiological workflow and patients' outcome [5].…”

Section: Introductionmentioning

confidence: 99%

Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density

et al. 2020

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Objectives Osteoporosis remains under-diagnosed, which may be improved by opportunistic bone mineral density (BMD) measurements on CT. However, correcting for the influence of intravenous iodine-based contrast agent is challenging. The purpose of this study was to assess the diagnostic accuracy of iodine-corrected vertebral BMD measurements derived from non-dedicated contrast-enhanced phantomless dual-layer spectral CT (DLCT) examinations. Methods Vertebral volumetric DLCT-BMD was measured in native, arterial, and portal-venous scans of 132 patients (63 ± 16 years; 32% women) using virtual monoenergetic images (50 and 200 keV). For comparison, conventional BMD was determined using an asynchronous QCT calibration. Additionally, iodine densities were measured in the abdominal aorta (AA), inferior vena cava, and vena portae (VP) on each CT phase to adjust for iodine-related measurement errors in multivariable linear regressions and a generalized estimated equation, and conversion equations were calculated. Results BMD values derived from contrast-enhanced phases using conversion equations adjusted for individual vessel iodine concentrations of VP and/or AA showed a high agreement with those from non-enhanced scans in Bland-Altman plots. Mean absolute errors (MAE) of DLCT-BMD were 3.57 mg/ml for the arterial (R2 = 0.989) and 3.69 mg/ml for the portal-venous phase (R2 = 0.987) (conventional BMD: 4.70 [R2 = 0.983] and 5.15 mg/ml [R2 = 0.981]). In the phase-independent analysis, MAE was 4.49 mg/ml for DLCT (R2 = 0.989) (conventional BMD: 4.82 mg/ml [R2 = 0.981]). Conclusions Converted BMD derived from contrast-enhanced DLCT examinations and adjusted for individual vessel iodine concentrations showed a high agreement with non-enhanced DLCT-BMD, suggesting that opportunistic BMD measurements are feasible even in non-dedicated contrast-enhanced DLCT examinations. Key Points • Accurate BMD values can be converted from contrast-enhanced DLCT scans, independent from the used scan phase. • DLCT-BMD measurements from contrast-enhanced scans should be adjusted with iodine concentrations of portal vein and/or abdominal aorta, which significantly improves the goodness-of-fit of conversion models.

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Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit

Cited by 29 publications

References 42 publications

Supportive Care: An Indispensable Component of Modern Oncology

Supportive Care: An Indispensable Component of Modern Oncology

Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention?

Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density

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