SoR responds to report raising concerns over ‘systemic failings’ in bone density scanning 

Royal Osteoporosis Society publishes results from a parliamentary inquiry, which reveals UK among the worst in Europe for bone scan services

Published: 16 January 2024 X-ray

The Society of Radiographers has responded to a new report raising concerns over the ‘systemic failings’ in the UK’s bone density scanning services. 

On 10 January, the Royal Osteoporosis Society published a report issued by an All Party Parliamentary Group (APPG) on osteoporosis and bone health, that revealed the failings in dual energy x-ray absorptiometry (DXA) services in the NHS. 

According to the report, titled ‘APPG on Osteoporosis and Bone Health - Review of DXA (bone density scanning) facilities’, 250,000 people per year are pointlessly exposed to harmful radiation due to bone scanning negligence in the NHS.

The report also revealed that DXA services also face workforce challenges, and highlights significant increases in both waiting times and numbers of patients waiting for a DXA scan. 

The APPG conducted an audit and hosted an evidence session where professional and patient experts presented their experience of osteoporosis and DXA services.

Among other key findings, the group concluded that:

  • The number of scanners per head of population in the UK is one of the lowest in Europe (23rd out of 29 countries)
  • There was evidence of services cutting corners in respect of their duties under The Ionising Radiation (Medical Exposure) Regulations 2017. Regulators expect employers to support individuals to meet regulatory and professional body requirements.
  • Long waiting lists are delaying access to treatment for people who are at high risk of fracture.
  • The knowledge and skills requirements to expand and develop the DXA workforce have been overlooked. There has been no accredited DXA reporting training available in the UK since the closure of the only course provider in 2022. While this course is due to restart in January 2024, having a single provider for the whole of the UK presents a risk to succession planning for education and training and continuity of care. 
  • Some services have stopped reporting DXA scans. Instead, referring clinicians are sent scan images with uninterpreted measurements. High quality reporting provides specialist interpretation of complex measurements and a clear steer to non-specialist clinicians, such as GPs, on the best management for that individual. Failure to report renders a DXA service unfit for purpose.
  • Compared to the other types of imaging, DXA has been neglected in the decisions around transforming diagnostics in the UK.

In response to the report, Craig Jones, chief executive of the Royal Osteoporosis Society said: “These systemic failings are putting tens of thousands of patients at risk of life-changing injuries which cost people their careers and, sadly in the case of many hip fracture patients, their lives. This is the result of chronic under-prioritisation of bone health in the NHS, which is nonsensical since fractures are the second biggest filler of hospital beds. 

“The government’s forthcoming Major Conditions Strategy won’t be fit-for-purpose unless it includes an actionable plan on bone health, including ensuring that DXA services are embedded in the new Community Diagnostic Centres as an early win.”

The report presents the national picture of DXA services in relation to the national diagnostic services:

  • In England, nearly one third of services are not compliant with the six-week diagnostic standard in the NHS England Constitution and are in breach of their Standard Contract.
  • In Scotland, while there is not an explicit diagnostic standard for DXA, there is an 18-week referral to treatment standard of which timely diagnostics is an essential part. Around 82 per cent of services had an average wait for a scan of more than six weeks, and 64 per cent had an average wait of more than 13 weeks.
  • In Wales, 83 per cent of services had an average wait of more than 13 weeks – in breach of their diagnostic standard of eight weeks. 
  • In Northern Ireland, at least 80 per cent of services had an average wait of more than 13 weeks – in breach of the nine-week diagnostic standard.

The SoR supports governance systems that ensure the delivery of high-quality scanning and reporting DXA services. There are several joint professional body guidance documents that detail the professional and clinical gold standards and the requirements of The Ionising Radiation (Medical Exposure) Regulations 2017 from referral to undertaking the exposure and making the clinical evaluation. 

It is concerning that the APPG report has exposed evidence of corner cutting as this presents potential risks to the patient, the healthcare professional and the employer. 

Withdrawal of a clinical evaluation is significant. This is a non-compliance under the regulations, and if images are interpreted by individuals who have not been adequately trained, patients may miss out on treatment, receive inappropriate treatment, and be put at increased risk of fracture. 

The SoR continues to campaign for investment in equipment and staff to address the diagnostic waiting list backlog and meet the rising demand.

We urge the government to invest in the infrastructure of this vital preventative public health resource and support the provision of targeted training and education for the acquisition, reporting and delivery of preventative and treatment plans for patients.  

The review identified good practice and calls for consistency in the provision of resources and training across the UK. The SoR acknowledges the existing wealth of expertise among the radiographic workforce and encourages the government to work with all stakeholders to improve the experience and prevent future suffering of thousands of people currently waiting for DXA scans. 

SoR notes the point made by Craig Jones, chief executive of the Royal Osteoporosis Society, that fractures are the second biggest filler of hospital beds in the NHS.

Reducing bed stays through fracture prevention offers wide reaching benefits to the health and care system.

Read the full APPG report here

(Image: Izusek/Getty Images)