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

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.

Clinical Data:
Gender
Indication:
Select one:
Lumbar Spine:
Hip:
Side:
Coments:

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

Prior Exam:
Has prior study to compare?
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