Is it okay for a patient with a Percutaneous Coronary Intervention (PCI) implant to undergo a Dual-Energy X-ray Absorptiometry (DXA) scan?

Safety of DXA Scanning in Patients with PCI Implants

Yes, it is completely safe for a patient with a Percutaneous Coronary Intervention (PCI) implant to undergo a Dual-Energy X-ray Absorptiometry (DXA) scan. 1

Understanding DXA and PCI Compatibility

DXA scanning is a low-radiation imaging technique used primarily to measure bone mineral density. According to the most recent practice guidelines, PCI implants (coronary stents) are not listed among the contraindications or artifacts that would interfere with DXA scanning 1.

Why DXA is Safe with PCI Implants:

1. Location considerations:

   • PCI implants (coronary stents) are located in the coronary arteries of the heart
   • DXA scans typically focus on the lumbar spine, hip, or forearm regions
   • The coronary stents do not overlap with the standard measurement sites

2. Metal artifacts in DXA:

   • While the guidelines mention that "surgical material and hardware projecting on the vertebral body" can cause artifacts 1, coronary stents are:
     • Too small to create significant artifacts
     • Located in a different anatomical region than the measurement sites
     • Not in the direct path of the DXA beam during standard positioning

Technical Considerations for DXA Scanning

When performing a DXA scan on a patient with a PCI implant, standard protocols apply:

• The patient can be positioned normally for lumbar spine, hip, or forearm measurements
• No special precautions are needed specifically for the coronary stents
• Standard patient preparation applies: removing only metal objects from clothing 1

Alternative Measurement Sites if Needed

In the unlikely event that a patient has both coronary stents and other hardware that might interfere with standard measurement sites, the guidelines provide alternatives:

• If spine measurements are compromised, hip measurements can be used
• If hip measurements are compromised (e.g., due to hip arthroplasty), the contralateral hip should be used 1
• If both spine and hip measurements are unavailable, forearm measurements can be performed 1

Clinical Perspective

From a clinical standpoint, patients with PCI implants often benefit from bone density assessment because:

• They may have cardiovascular risk factors that overlap with osteoporosis risk factors
• They may be on medications that could affect bone health
• Regular monitoring of bone health is important for comprehensive care

Conclusion

DXA scanning is safe and appropriate for patients with PCI implants. The coronary stents used in PCI do not interfere with DXA measurements of bone mineral density, and no special precautions are required beyond standard DXA protocols.