Bone Density 101 Ben Williams DEXA Solutions, LLC BS Biomedical Engineering (SLU) 17 years in the DXA industry

DXA – Dual-Energy X-Ray Absorptiometry Most common method for determining bone density Why not an exact science? BMD = BMC (g)/A (cm^2) Error Variations between OEMs Differences in technologists Service performed incorrectly T-Score and Z-Score -1 and above = normal Between -1 and -2.5 = Osteopenic -2.5 and lower = Osteoporosis Z-Score of 0 is average

DXA – Dual-Energy X-Ray Absorptiometry (continued) Common measurement sites (reimbursed) AP Spine Femur (Dual Femur) Forearm LVA (lateral vertebral assessment) Reimbursement varies Additional Applications (currently no reimbursement) Total Body and body composition CoreScan Pediatric Orthopedic

Why a Needed Technology? Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds Osteoporosis is estimated to affect 200 million women 1 in 3 women over 50 will experience osteoporotic fractures, as will 1 in 5 men $14 Billion/year cost in US only

OEMs and Models of Densitometers GE Lunar iDXA Prodigy DPX (NT, Duo, Bravo) DPX (IQ, alpha, L) Peripherals (Achilles) Hologic Discovery Series Horizon QDR Series Peripherals (Sahara) Norland XR Models

System Overview – Lunar Basic Function and Setup Lunar systems are controlled by DOS, WIN95/98/XP/7 workstation using the Encore Software (does have a service mode for troubleshooting and calibration – different passwords for different versions). PC communicates to SBC Board via RS422/232 Serial card SBC (controller for all modern models) gives commands (motion, x-rays, etc…) Systems use 110V AC (20A dedicated outlet recommended by OEM) Isolation transformer used to limit leakage currents UPS used for isolation transformer and Scanner power Printer for reports (unless configured to send electronically)

System Overview – Lunar 3 Sub Systems X-Ray Generation Tube Power Supplies X-Ray Detection CZT Detector Detector Electronics Scanner Control Motion Control Error Detection Communications with Host PC / Detector

System Overview – Lunar Schematic

System Overview – Lunar Common Failures Tube Arc Typically the tube, but could be caused by HVPS HVPS Enable and Disable failures Broken Cable Shutter Failures PC Failures Deteriorated Detector (NT, Duo, Bravo, IQ)

System Overview – Lunar Troubleshooting Error Log Tools – Error Log – Print all errors Arcing Look for oil leaking from tube’s expansion chamber Older models may need regreased O-ring inside collimator deteriorates Determine sub system (x-ray generation, detection or scanner control) Verify voltages on DC Supply (+/- 12V and 5V) Places to check voltage: DC Supply, DIB Board; Bulkhead connection

System Overview – Hologic Troubleshooting

System Overview – Hologic Troubleshooting

System Overview – Lunar Connectivity Printed Reports Generally using a color printer PACS Configure DICOM and Worklist EMR (HL7 Work-Around) Install Adobe Writer Install, or connect to, EMR software Create reports as .pdf Upload to EMR

DXA Market Today Reimbursement down 70% in some areas Many PC facilities not maintaining densitometers Shift back toward traditional market Used and refurbished markets growing

DXA Market Tomorrow DXA offered primarily in traditional market facilities Increase in availability overseas Huge push in “preventative care” Body Composition Type to enter a caption.

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Questions??? Ben Williams President DEXA Solutions, LLC F: 608-338-0431 Customer Support: 855-844–3392 http://www.dexasolutions.com