Dual-energy X-ray absorptiometry in clinical practice: application and interpretation of scans beyond the numbers

Dual-energy X-ray absorptiometry (DXA) is widely used for measurement of bone mineral density (BMD). In routine clinical practice, a diversity of DXA scan findings that deviate from anticipated anatomical landmarks and require a sophisticated approach to patient positioning and scan analysis may be identified. Recognition of various artifacts and pathologic processes that can falsely increase the measured BMD is essential to accurate DXA scan analysis. Critical evaluation of the DXA scan image, and careful appraisal of numeric data on the computer-generated printout by clinicians and radiology technologists are instrumental to ensure correct DXA scan interpretation. We demonstrate a spectrum of incidental findings that may influence BMD measurements and analyze common pitfalls of DXA scan interpretation. Radiographic correlation can help further evaluate a suspected abnormality displayed on the DXA image.