Factors Affecting Short-Term Bone Density Precision Assessment and the Effect on Patient Monitoring
Bibliographic record
Abstract
UNLABELLED: The most widely used procedure for performing a BMD reproducibility assessment (same-technologist with simple repositioning on the same day) systematically underestimates precision error and will lead to over categorization of change in a large fraction of monitored patients. INTRODUCTION: The most common procedure for establishing the least significant change (LSC) to monitor bone mineral density (BMD) with DXA is for the same technologist to perform repeat subject scans on the same day with simple repositioning. The objective of the current report is to determine how the reproducibility scanning procedure impacts on the precision assessment and categorization of change in routine clinical practice. MATERIALS AND METHODS: The study population was drawn from the database of the Manitoba Bone Density Program which includes all clinical DXA test results for the Province of Manitoba, Canada. All patients who had baseline and follow up total spine (L1-4) and the total hip BMD measurements on the same instrument up to March 31, 2007 were included as the 'clinical monitoring population' (N = 5048 scan-pairs). BMD precision was assessed in a convenience sample of patients who were agreeable to undergoing a repeat assessment (50% performed on the same day with repositioning, 68% by different technologists) (N = 331 spine and 328 hip scan-pairs). RESULTS: Precision error was greater when the scan-pairs were acquired on different days than on the same day for both the total spine (p < .001) and total hip (p < .01). No other factor was consistently associated with precision error. The reference LSC (different days and different technologists) categorized the smallest fraction of the monitored population with change, whereas other combinations gave a significant rate of over categorization (up to 19.3% for the lumbar spine and up to 18.3% for the total hip). CONCLUSIONS: The most widely procedure for performing a BMD reproducibility assessment (same-technologist with simple repositioning on the same day) systematically underestimates precision error and will lead to over categorization of change in a large fraction of monitored patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.045 | 0.246 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".