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What is the OsteoGram?
The OsteoGram is a system that measures bone mineral density (BMD) at middle phalangeal bones of the hand. Using standard x-ray equipment a hand x-ray is taken then analyzed using the OsteoGram.
What are the components of the OsteoGram system?
The OsteoGram system consists of a computer with factory installed software, a monitor and a scanner.
What are the OsteoGram’s indications to use?
The OsteoGram has been cleared by the FDA to be used for diagnosing osteoporosis, monitoring bone mass measurements over time and predicting fracture risk.
What is the reproducibility degree of OsteoGram results?
The OsteoGram precision is excellent, more than 99% (or precision error is less than 1%). This is based on assessing the consistency of OsteoGram results if the tests were to be repeated many times.
How accurate are the OsteoGram results?
The OsteoGram accuracy is excellent, more than 95% (or accuracy error is 4-5 %). This is based on comparing the OsteoGram to the ultimate test for bone mineral measurement, ashed bone weight in cadaveric studies. The correlation coefficient (r) is another way of expressing this comparison, on a scale of one this correlation is 0.983.
How does the OsteoGram compares to DXA?
The OsteoGram has precision and accuracy that are comparable to DXA. Studies show correlation coefficient between the two methods as high as 0.87. Patient radiation dose is significantly less with OsteoGram.
Which bones are considered for BMD measurements?
The middle (second) phalangeal bones of the index, middle and ring fingers.
Can the OsteoGram measure bone density at the hip or spine?
No, the OsteoGram was developed to measure BMD of middle phalangeal bones of the hand.
Isn't it necessary to measure bone density at the hip or spine to diagnose osteoporosis?
Not with the OsteoGram that precisely and accurately measures phalangeal BMD, which has been proven to be a significant indicator of BMD at other sites of the body.
Isn't it necessary to measure bone density at the hip or spine to assess hip or spine fracture risk?
Not with the OsteoGram that has been specially tested for this purpose. Studies in the late 90’s showed that the OsteoGram can be used for spine and non-spine fracture risk prediction with high reliability.
What expertise is needed to take a hand x-ray for the OsteoGram?
All Radiographic Technologists (RTs) who can take standard x-rays qualify, no special expertise needed.
Can any x-ray film be used?
X-ray films must be size 8"x10".
What technique (x-ray settings) should be used to take the hand x-ray?
Any technique that results in a developed radiograph with a background gray shade for both exposures of 1.1 ± 0.2 optical density (OD).
How can the required 1.1 optical density be verified?
It can be verified on a light box by:
  • Comparing the background of your x-ray to the background of the supplied sample x-ray, or:
  • Comparing the background of your x-ray to an optical calibration step wedge, or:
  • Measuring the density of the background of your x-ray using an optical densitometer
The required 1.1 optical density looks too light! Is this the right way of doing an OsteoGram x-ray?
Yes, the OsteoGram requires less contrast than normal x-rays.
There are instructions suggesting different x-ray settings for the two exposures, how crucial is that?
What's crucial is obtaining a developed radiograph with a background gray shade of 1.1 OD. A difference of 10 kV is suggested between the settings of the two exposures (this means that the mAS has to be reduced for the exposure with high kV). However, any difference up to 10 kV, as well as the same kV setting may be used as long as the required gray shade of 1.1 OD is met.
Is the OsteoGram a double energy technology?
No, it is a single energy method that uses the technique of Radiographic Absorptiometry.  It needs two exposures for Quality Assurance purposes not as a requirement for double energy.
If the OsteoGram can analyze one x-ray exposure then why the need for two exposures?
For Quality Assurance (QA) purposes the technology of the OsteoGram was developed for two exposures. This QA process consists of two stages. The first QA stage serves in verifying x-ray equipment. The second QA stage (when the first complies) serves in verifying the consistency of results between the two exposures for each finger. However, the OsteoGram can adequately analyze one x-ray exposure, which is an option that can be seen upon choosing a "New Test". This option has been made available for rare cases where one exposure (out of two) is not suitable for analysis and an assessment is still needed. To obtain the best results, the OsteoGram must always be used with two valid exposures.
Some patients have already done hand x-rays for various reasons, can these x-rays be used with the OsteoGram?
No, any x-ray taken without the aluminum wedge does not qualify for OsteoGram analysis.
Why is the aluminum wedge important?
The aluminum wedge serves as the standard reference against which bone mass measurement are calculated.
What expertise is required to operate the OsteoGram system?
Any operator can run the OsteoGram analysis, no expertise required.
Is there anything in the BMD analysis process that the operator should be aware of?
Yes, when the automated BMD analysis is completed the operator should visually inspect both exposures and make sure that the three phalanges in each exposure have been accurately outlined with the blue line. If one or more bones were not outlined or were improperly outlined, the operator is required to interfere to adjust the outline as described in the manual.
What are the Quality Assurance/Quality Control (QA/QC) measures of the OsteoGram?
QA/QC is imbedded in the system for each step of the analysis process. For periodic testing, an OsteoGram test must be done on a weekly basis with the provided calibration x-ray. If the BMD reading of a test does not fall within the range written on the calibration x-ray contact CompuMed.
Is the OsteoGram reimbursable by Medicare?
Yes, the OsteoGram is reimbursable by Medicare and the vast majority of third-party payors in the U.S., the Current Procedural Terminology (CPT) codes are:
73140: Radiographic examination, fingers, two views
76078: OsteoGram analysis
What is reimbursement amount for OsteoGram’s CPT codes?
It varies depending on location. The national average (92 areas) payment amount in Medicare Physician Fee Schedule (MPFS) for 2001 is $24.50 for CPT 73140 and $42.12 for CPT 76078