DXA Report

Welcome! Bem-Vindo! Benvenuti

This formulary was build to help you to make DXA structured reports.

This website does not use cookies and does not collect any browsing data.

The template follows the International Society for Clinical Densitometry (ISCD) positions: ISCD

For children, adolescents, premenopausal women and men age less than 50, choose the Z-score formulary.

New: Test a customized version for your company

Clinical Data:

Name:

Gender

Female

Male

Birth Date:

Exam Date:

Indication:

Referring Physician:

Lumbar Spine:

T-score Lumbar

BMD Lumbar

Lumbar Levels

Hip:

Side:

Left

Right

T-score Femoral Neck:

BMD Femoral NecK:

T-score Total Hip:

BMD Total Hip:

Coments:

Statement regarding technical quality,artifacts,and reason(s) for exclusion of vertebral bodies and/or other skeletal sites.:

Technical Quality:

Densitometer

Prior Exam:

Has prior study to compare?

Yes

No

Prior Exame Date

Prior Lumbar Spine BMD

Prior Femoral Neck BMD

Prior Total Hip BMD

Report:

Dual-Energy X-ray Absorptiometry (DXA) Report

Clinical History:

Referring Physician:

Indication:

Results:

LUMBAR SPINE :

FEMUR :

Technical Quality and Coments:

IMPRESSION:

Based on BMD diagnosis is consistent with (WHO criteria)

Prior exam:

Fracture Risk:

To evaluate fracture risk in patients in accordance with the ISCD/NOF recommendations, visit FRAX site.: FRAX

Links

Connect

Linkedin